tag:blogger.com,1999:blog-37216099995098375632024-02-29T02:27:03.192-05:00Treatment Scores BlogUnknownnoreply@blogger.comBlogger149125tag:blogger.com,1999:blog-3721609999509837563.post-37698828011214676712020-09-17T12:13:00.005-04:002020-12-16T20:59:08.003-05:00The “Moneyball for Medicine” Statistic was Invented a Long Time Ago – it’s called the “Treatment Score”
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN7R3Sjr5daXTOKOM6lrd_LQQ5bf7ar1fVXiLDWSdmUa3MCRClpqvyILghjwgyKou-5ptEeT2uVI3bEvX8-qFFPz1ACcc1LihX6knqJ4dGI2G68CEz1Syvv_aaxy_RByYWMIO3CiLtnuQ/s600/Moneyball+600x338x100+2+BORDER.png" style="margin-left: 1em; margin-right: 1em;"><img alt="The Moneyball for Medicine Statistic" border="0" data-original-height="348" data-original-width="600" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN7R3Sjr5daXTOKOM6lrd_LQQ5bf7ar1fVXiLDWSdmUa3MCRClpqvyILghjwgyKou-5ptEeT2uVI3bEvX8-qFFPz1ACcc1LihX6knqJ4dGI2G68CEz1Syvv_aaxy_RByYWMIO3CiLtnuQ/w320-h186/Moneyball+600x338x100+2+BORDER.png" title="The "Moneyball for Medicine" Statistic" width="320" /></a></div><div style="font-weight: bold;"><b><br /></b></div><div><b style="font-weight: bold;">The “Moneyball for Medicine” statistic was invented a long time ago. </b>It was invented by an Anesthesiologist with an undergraduate degree in mathematics and by an Emergency Medicine Physician with an undergraduate degree in economics. It combines the math of medical statistics with the math of economics. </div><div style="font-weight: bold;"><br /></div><div>The “Moneyball for Medicine” statistic is the “expected net treatment benefit for the patient using the outcome measure most important to the patient.” It’s the long-needed statistic that puts the patient first. </div><div><br /></div><div>What do you need to know when you get sick? </div><div><ol style="text-align: left;"><li>You need to know your diagnosis </li><li>You need a list of all possible treatments </li><li>Then you need to know the “expected net treatment benefit” from each treatment for someone like you.</li></ol></div><div>We call the “expected net treatment benefit for the patient, based upon the outcome most important to the patient,” the Treatment Score. The higher the Treatment Score the better for the patient. </div><div><br /></div><div>The Treatment Score is calculated using all three steps of evidence-based medicine: </div><div><ol style="text-align: left;"><li>The medical literature </li><li>The physician’s knowledge </li><li>The values and preferences of the patient. </li></ol></div><div>Note that the patient can’t be left out of evidence-based medicine. The patient is the essential third step of evidence-based medicine (EBM). Evidence-based medicine is supposed to be personalized and individualized. The Treatment Score makes Evidence-based medicine quantifiable down to one number, making treatments understandable at a glance, and creates the ability to do real value-based care. The overall concept is simple and would look like this on your smart phone: </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhag0uIdruupNSBt6Yf5TbxgMauont2z4GbEJwVXEq56r-RZ-aVYzJifEFVdCCNfzXWPbKLwSogQ-3mGW43h5Dv4iBU9C3PaBOWDqNb_I76bCXkNFU_mqL_iu7_f6R0mSfcewUPXTtWhTU/s313/Treatment+Treatment+Score+4+BORDER.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Treatments and Treatment Scores" border="0" data-original-height="189" data-original-width="313" height="242" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhag0uIdruupNSBt6Yf5TbxgMauont2z4GbEJwVXEq56r-RZ-aVYzJifEFVdCCNfzXWPbKLwSogQ-3mGW43h5Dv4iBU9C3PaBOWDqNb_I76bCXkNFU_mqL_iu7_f6R0mSfcewUPXTtWhTU/w400-h242/Treatment+Treatment+Score+4+BORDER.png" title="Treatments and Treatment Scores" width="400" /></a></div><br /><div>This table is saying that Treatment 1 is 100% effective and Treatment 5 is 0% effective for whatever outcome measure you are using. This organizational system can be used for curing cancer or resolving the symptoms of the common cold. </div><h1 style="text-align: left;">Here’s What the Future Should Look Like </h1><div>You suffer from insomnia. You go to the physician and he or she says pulls out their smart phone and says, “Here’s a list of all 498 treatments for insomnia (from WebMD) and to the right of each treatment is the Treatment Score as calculated by me, using my values and preferences.”
You can see the same list of treatments and Treatment Scores on your smart phone, and you can learn to adjust them based upon your values and preferences with the help of your physician to complete the third step of evidence-based medicine. </div><h1 style="text-align: left;">Pancreatic Cancer </h1><div>Perhaps you are diagnosed with stage 4 pancreatic cancer, which is a lethal, horrible, cancer. Actor and celebrity, Patrick Swayze, died from it. The five-year survival is 1% (Johns Hopkins) and most patients don’t even live as long as one year. </div><div><br /></div><div>Alex Trebek of JEOPARDY made it through his one-year milestone (he posted this). Mr. Trebek should have been able to scroll through a list of treatments with Treatment Scores as calculated by his treating physician on his physician's smart phone. Then, Mr. Trebek should have been able to consider his values and preferences as a patient on his smart phone, with and without, his physician, and adjust his Treatment Scores. His physicians probably did something like this, but they probably did not quantify their thinking down to one number as we need to do now for all medical treatments, and they probably did not quantify all the side effects with a trail of data to show how they got their numbers and why. Mr. Trebek died on November 8, 2020, so he survived less than two years after diagnosis.</div><div><br /></div><div>Quantification disrupts every industry it touches. Quantification will change healthcare forever. Let’s expand our example to see what pancreatic cancer might look on your smart phone where it could fit inside two columns: </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr3YlN_C6ITS_z6t7a0QP8YsCXBoIMaCjM6zDNMqoFpo7pIgHD4pIHL9nsA4NC2TBDK6dMOG-Ftw67XAUl91XkyHV-QZ1s_usj_JRyez05ilZKNFpvUNGWElLJiTsiIOVfDNdPoGUGieY/s645/pancreatic+2.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Treatment Scores on a smart phone" border="0" data-original-height="406" data-original-width="645" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr3YlN_C6ITS_z6t7a0QP8YsCXBoIMaCjM6zDNMqoFpo7pIgHD4pIHL9nsA4NC2TBDK6dMOG-Ftw67XAUl91XkyHV-QZ1s_usj_JRyez05ilZKNFpvUNGWElLJiTsiIOVfDNdPoGUGieY/w400-h251/pancreatic+2.png" title="Treatment Scores on a smart phone" width="400" /></a></div><br /><div>What is this table saying? It is saying that the Patrick Swayze protocol had a 5-year overall survival increase of 0% based on his one example. Patrick Swayze died 20 months after his diagnosis of Stage IV pancreatic cancer, according to various reports, so he did not make it to five years. </div><div><br /></div><div>This table is saying we won’t know the 5-year Treatment Score for Alex Trebek because his five-year anniversary of being diagnosed won’t be until March 4th, 2024. We hope he breaks through that milestone! </div><div><br /></div><div>My treatment protocol has an “expected net treatment benefit” = Treatment Score of 2% for increasing my 5-year overall survival if I’m lucky. I got my treatment protocol from reading the medical literature, getting my physician’s advice (me), talking to other physicians, and by using my values and preferences. Thus, I used all three steps of evidence-based medicine to calculate my Treatment Score. I don’t have pancreatic cancer; I just worry about getting it! Like many statistics, my Treatment Score has a range, and because stage IV pancreatic cancer is so deadly part of that range is below zero, so I, like most people, might not live five years. It may turn out the Treatment Score would be zero for me like it turns out to be for most people. However, at least I would have made my decision using the best data available, and would have used evidence-based medicine that was personalized to me. (Note, I am not actually claiming that “my protocol” is a hard science EBM score that is positive at 5-years; this is just an example.) </div><div><br /></div><div>My treatment protocol would be much different from what Patrick Swayze did or from what Alex Trebek did, because as a physician, I am much more focused on quality of life rather than length of life, because I have seen the horrible side effects cancer patients suffer from their treatments. This is not an uncommon attitude among physicians. I have known cancer patients who were so miserable from their treatment that they did not want to live after being treated, even though they survived. I do not want to go through that kind of suffering. There are definitely cases where the Treatment Score is statistically likely to be negative, meaning harmful, for a cancer treatment, and I will avoid all those treatments like the plague. </div><div><br /></div><div>It’s very telling that the Pancreatic Cancer Action Network (PanCAN), “strongly recommends clinical trials….” Even they are basically saying nothing works, at least not at the 5-year mark. Once we figured this out, we would shift our main outcome measure to 1-year overall survival. This has to be done for many of the deadliest cancers to get a positive Treatment Score. </div><div><br /></div><div>Surely, you can see that not having a list of treatments with Treatment Scores done right now and available to all patients on the Internet is a catastrophe. If you get diagnosed with stage IV pancreatic cancer, as a patient it could easily take you a year to do your research, read all the studies, get all the advice you can, and figure out how you want to treat it. But by 1 year, about 80% of patients will be dead. </div><h1 style="text-align: left;">Steve Jobs </h1><div>Steve Jobs was diagnosed with stage 1 neuroendocrine pancreatic cancer, the most curable type. Mr. Jobs, according to reports and books about him, underwent many treatments. Please take all these with a grain of salt even though I have references at the end, because Mr. Jobs is not here to explain what he did and why, or if he actually considered these things to be treatments. Reportedly, Steve Jobs may have done things like: </div><div><ul style="text-align: left;"><li>vegan diet </li><li>acupuncture </li><li>herbal remedies </li><li>psychic therapy </li><li>organic herbs </li><li>juice fasting </li><li>bowel cleanings </li><li>hydrotherapy </li><li>expression of negative feelings </li></ul></div><div>Using the hard science rules of evidence-based medicine, which require high quality studies in human beings, many of things Steve Jobs may have done according to various reports (which may or may not be accurate), would have had a Treatment Score of zero. </div><div><br /></div><div>The possible irony and tragedy of Steve Jobs’ death cannot be overlooked. If our current system can’t explain medical statistics to an intelligent, high-tech person, such as Steve Jobs, then we have failed. Monday morning quarterbacking is easy, but we need to ask ourselves, “Would Steve Jobs be alive today if he had had Treatment Scores?” If Mr. Jobs had understood the medical statistics? The irony is that one of the inventors of the hardware, the iPhone, that is changing healthcare did not have the software on it, Treatment Scores, that might have saved his life. But we are guessing, because no one I personally know has the details of his situation, nor does anyone know if the disease would have progressed regardless of treatment. </div><div><br /></div><div>We can honor Steve Jobs posthumously by listening to what he said: “You've got to start with the customer experience and work back toward the technology—not the other way around.” Steve Jobs, (May 1997, World Wide Developers Conference). This is what we need to do with Treatment Scores.</div><h1 style="text-align: left;">Mathematics </h1><div>You can click on each Treatment Score and follow the trail back to where it originated, and you can study every value, calculation, and reference along its path. The Treatment Score combines the math of medical statistics with the math of economics, and digests it all down to one number. Here’s one conceptual example of the math involved: </div><div><ul style="text-align: left;"><li>1 diagnosis </li><li>10 possible treatments for that diagnosis </li><li>10 vital statistics for each of those treatments </li><li>10 references used to get those 10 vital statistics </li><li>10 pieces of data for each reference. </li></ul></div><div>That's 10×10×10×10 = 10,000 pieces of information that must be processed and transformed into a Treatment Score. Yet, with computers it can all be quite simple. We have already created working software to do it. </div><div><br /></div><div>Let’s explain it simply. If you run a business, every year you need to know your “net income” for that business. Of course, you start with your “gross income” to get to your “net income.” </div><div><br /></div><div>The same thing for taxpayers doing their taxes every year. You have to start with your “gross income” and figure out your “net income” to pay your taxes. </div><div><br /></div><div>The formula is: gross income – expenses = net income. </div><div><br /></div><div>For medical treatments the formula is: gross treatment benefit – negative side effects = net treatment benefit. </div><div><br /></div><div>It’s more complicated with medical treatments because there can be “side benefits” to a medical treatment. For example, proponents of medical marijuana for treating nausea from chemotherapy will often mention the side benefit of medical marijuana treating pain as well. There are many examples of medical treatments that have both negative side effects and positive side benefits. The formula becomes: </div><div><br /></div><div>Gross treatment benefit – side effects + side benefits = net treatment benefit. </div><div><br /></div><div>Subtracting the side effects is extremely important. There are patients who say that being incontinent of feces, or incontinent of urine, would be worse than death for them. There is a brain tumor surgery that can cause a complete and horrific paralysis of one side of the face. Many patients say that this side effect would be worse than death for them. Many patients would subtract a lot for the side effect of peripheral neuropathy—which can be a constant painful side effect of the skin for the rest of one’s life.</div><div><br /></div><div>“Side benefits” cannot be overlooked either. Many people think chronic pain patients are being crucified by “medical guidelines,” which are not evidence-based medicine, but are only step 1 of EBM. A pain pill may decrease pain, but it may also have very important positive side benefits:</div><div><ul style="text-align: left;"><li>Enabling the bedridden to get out of bed </li><li>Increasing all physical activity </li><li>Decreasing suicidal ideation </li><li>Decreasing suicides </li><li>Increasing mental clarity </li></ul></div><div>When treating a chronic pain patient, like somebody who has had four failed back surgeries, you must add these positive side benefits into the equation to get an accurate Treatment Score. You can’t just focus on the well-known negatives. Doing Treatment Scores would greatly help to sort out the management of chronic pain patients. Treatment Scores would ensure that the values and preferences of the individual patient are included. </div><h1 style="text-align: left;">Insomnia</h1><div>Let's speak again of insomnia again. So many people have trouble sleeping! There are 498 treatments for insomnia listed on the WebMD website. So the math is like this: </div><div><br /></div><div>Diagnosis: Insomnia</div><div><ul style="text-align: left;"><li>498 treatments</li><li>10 vital statistics for each treatment</li><li>10 references for each vital statistic</li><li>10 pieces of data for each reference</li></ul></div><div>That's 498 x 10 x 10 x 10 = 498,000 pieces of data that must be summarized into Treatment Scores using evidence-based medicine guidelines.</div><div><br /></div><div>This is why we need computers. One diagnosis can have about half a million (500,000) data points that must be incorporated. Fortunately, we have everything we need to create understandable treatment transparency for patients: the Internet, new database technology, and new medical statistics. </div><div><br /></div><h1 style="text-align: left;">The Money Example </h1><div>This simple equation: </div><div><br /></div><div>Gross treatment benefit – side effects + side benefits = net treatment benefit, still confuses people. It’s because all of these things are on different scales and have to be converted to be on the same scale. </div><div><br /></div><div>It’s like our main outcome measure is in dollars, but our side effects are in other currencies such as pesos, British pounds, and Euros. With Treatment Scores, math is used to create conversions for all side effects and side benefits so that they can all be put on the same scale. These conversion factors come from patients, so again, Treatment Scores put the patient first! </div><div><br /></div><div>Here is a graphic of calling the main outcome measure, perhaps 5-year overall survival, “dollars,” to help with the flow of doing conversions to get the main outcome measure, the side effects, and the side benefits all on the same scale: </div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnMCL6r9MAfHsRiaMulOMcrYByhQxOn0zca3Ob03uLWOy6Ppfs59oqzxMjQFdRlUxjS8rm2MZAopFitlMKW8kgeVhnIQOxLQ0fokfqDX53cdANKZ076OucaGslaL_gc0RH6zbIH_baJp8/s695/flow2.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Treatment Scores flow chart" border="0" data-original-height="611" data-original-width="695" height="351" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnMCL6r9MAfHsRiaMulOMcrYByhQxOn0zca3Ob03uLWOy6Ppfs59oqzxMjQFdRlUxjS8rm2MZAopFitlMKW8kgeVhnIQOxLQ0fokfqDX53cdANKZ076OucaGslaL_gc0RH6zbIH_baJp8/w400-h351/flow2.png" title="Treatment Scores flow chart" width="400" /></a></div><br /><div>Remember, we are just taking the outcome measure most important to the patient, such as 5-year overall survival, and are converting the side effects and side benefits onto that same scale so we can summarize the treatment into one number. It’s like adding up dollars, pesos, British pounds, and Euros, where “dollars” actually stands for 5-year overall survival, or some other outcome measure important to the patient. </div><h1 style="text-align: left;">57 Treatments that Don’t Work </h1><div>Patients often undergo medical treatments without realizing they have almost zero chance of helping them.
During their 4.4-year study, Chul Kim, MD, MPH, and Vinay Prasad, MD, MPH, found that 31 FDA approved chemotherapy drugs did not improve overall survival or had no solid proof they improved overall survival. </div><div><br /></div><div>In other words, 31 medications had a Treatment Score of zero! Maybe less than zero because of their side effects. Yet, all these treatments can be used, and can be reimbursed, because they are FDA approved. I do not think that a treatment that works 0% of the time, according to evidence-based medicine, for the outcome I want should be reimbursed at the same rate as a medication that works 99% of the time. Sadly, this is how the system currently works. </div><h1 style="text-align: left;">Cancer Scams </h1><div>Here’s how a “cancer scam” works even in the best, most legitimate, places. Someone tells the patient they have cancer. Then they proceed to “scare the hell out of the patient,” as the idiom goes. The patient becomes very afraid. The medical industrial complex with its information monopoly throws in frightening words about what could happen: death, metastases, pain, agony, and so forth. </div><div><br /></div><div>But it may be one of those cancers that is unlikely to ever kill you. You may have no idea, you just know “cancer!” You keep hearing the word: cancer, cancer, cancer, bounce around inside your head. The patient is led into making an emotional decision based on fear and does harm to themselves financially (a wallet biopsy), and physically because of horrible side effects, when there were better options. If the patient had understood the situation, they might have made different choices. Some people get very rich off of this information monopoly. Search “overtreatment” and you will find over 1.5 million results, and not just for cancer. </div><h1 style="text-align: left;">Paternalistic Medicine is Bad Medicine </h1><div>In healthcare, the default has been to just have the doctor tell you what to do—paternalistic medicine. Yet, paternalistic medicine has been declared unethical many times. After the epidemic of unnecessary hysterectomies performed on women, paternalistic medicine was declared unethical. Paternalistic group-think medicine was declared unethical after many patients were given antiarrhythmic drugs only to have independent studies prove later that the drugs were killing people. Paternalistic medicine was denounced at the Nuremberg Trials in favor of informed consent, which means shared decision-making with the patient. Tragedies like these are why we want every doctor and patient to be able to go to the data themselves and evaluate it, using software. You must be your own best healthcare advocate and your doctor must put you first. </div><div><br /></div><div>We are still doing far too much paternalist medicine. In the old days, the doctor told the patient what to do. These days, someone writes guidelines telling doctors what to do, and then the doctors tell the patient what to do according to the guidelines. It’s paternalist medicine one step removed. Guidelines are dressed up as evidence-based medicine, but they are only the first step of evidence-based medicine, a review of the medical literature. Guidelines, systematic reviews, and meta-analyses are not evidence-based medicine, as without the last two steps: the physician’s input and the patient’s values and preferences, EBM is not complete. Search “critique of meta-analyses” and “critique of guidelines” and “critique of systematic reviews” and you will find well over 1 million search results. </div><div><br /></div><div>It is hard to emphasize this enough, “medical guidelines” by Academia, Government, or Industry, are not evidence-based medicine, because they do not necessarily include the essential second and third steps of EBM, the physician who knows the patient the best, and the individual patient. Guidelines leave out the individual patient’s values and preferences and guidelines are not personalized medicine or individualized medicine. </div><h1 style="text-align: left;">Bias in the Medical Literature </h1><div>The bible roughly says, “the love of money is the root of all evil.” Notice the importance of the word “love.” Some people can act in a logical and unbiased manner regardless of money and some cannot. Money in and of itself is a tool, not an evil. </div><div><br /></div><div>Power is similar, it can be good or bad. “Power corrupts: absolute power corrupts absolutely,” was an observation by Lord Acton (shorted by me). Lord Acton was a politician born in 1834 and he warned us! </div><div><br /></div><div>In short, money or power can cause bias in the medical literature, and there are three main sources of bias in the medical literature: </div><div><ol style="text-align: left;"><li>Academia</li><li>Government </li><li>Industry. </li></ol></div><div>Treatment Scores account for all of these biases. One way to counter these biases is transparency. Ideally, at the end of every medical study there should be a box for all three of these biases, and every author should check the appropriate box, or boxes, and declare all money received in their lifetimes up to the point of writing their study from these sources. Many doctors are totally unaware of the “dark” or “hidden” money they have received during their lifetimes and its subtle influence. Medical students and residents are particularly clueless in my experience. </div><div><br /></div><div>These statements are somewhat true: “You can buy a scientist just as easily as you can buy a politician,” and, “You can buy a physician just as easily as you can buy a politician.” There is actually more transparency about politicians than about scientists or physicians, so the bad politicians are more visible. I have met many scientists, physicians, and politicians, and the majority are great, smart people, but just like in all other walks of life there are some bad actors. This is why Treatment Scores emphasize mathematics and minimizes human bias. </div><h1 style="text-align: left;">John P.A. Ioannides, MD, DSc. </h1><div>Those of us who love math and hard science admire John P.A. Ioannides, MD, DSc., who famously wrote the article, “Why Most Published Research Findings are False.” We like Ioannides because we believe he is right. Medicine consists of a mountain of bad studies and a tiny hill of good studies. </div><h1 style="text-align: left;">Who should Calculate Treatment Scores? </h1><div>Why the emphasis on bias? Because there is tremendous bias in the medical literature. The ideal study is an unbiased, double-blinded, randomized controlled clinical trial, because the very purpose of a randomized controlled trial is to remove bias. Guidelines, systematic reviews, and meta-analysis done by humans can put bias back in. </div><div><br /></div><div>The ideal review of the medical literature would be done by an unbiased physician. Systematic reviews and meta-analyses are not unbiased, and I am not aware of an unbiased, double-blinded, randomized controlled clinical trial that proves that either a systematic review or a meta-analysis is better than an unbiased, double-blinded, randomized controlled clinical trial. Please re-read that! Have we adopted something as a new “Gold Standard” without doing the science to prove that it is a new and better Gold Standard? </div><div><br /></div><div>The next step in the evolution of medical information should be the “expected net treatment benefit” for the patient, using the outcome most important to the patient, done in an unbiased fashion, using math as much as possible, because math doesn’t lie and math can remove bias. </div><div><br /></div><div>You want physicians who are independent of Academia, Government, and Industry calculating Treatment Scores. You want independent physicians who are working directly for patients without any third parties (Academia, Government, or Industry) standing between the doctor and patient. If such third parties are involved, they need to disclose their past money from all three sources. This moral code should be obvious, but it is not. As a patient, you do not want third parties influencing physicians’ decisions. </div><h1 style="text-align: left;">Journal Clubs </h1><div>I have talked to many residency directors and resident physicians about Treatment Scores, and I can’t believe what I have heard! One Ivy League residency program is thinking of abandoning Journal Club altogether. Journal Club was one of my favorite parts of residency. Journal Club is important because you review all the latest medical studies and figure out what information is good enough to use. You also learn how to “Study a Study.” Residency directors have told me that nobody shows up for Journal Club, or they have to bribe residents with free food. This is wrong. All residency programs should be calculating Treatment Scores during Journal Club. Journal Club is life and death important. </div><h1 style="text-align: left;">Medical School Applicants </h1><div>We should be choosing students to enter medical school who are great at mathematics, medical statistics, and who are good at computer programming. We need to move in the direction of unbiased medical informatics to have a better future. Sadly, many studies show that patients are health illiterate, and worse, physicians are illiterate when it comes to medical statistics. The blind really are leading the blind! </div><h1 style="text-align: left;">Tumor Boards </h1><div>Many hospitals have a “Tumor Board,” which is a group of physicians that get together and go over the laboratory results and scans for the patient that has cancer and decides, as a group, how to treat the patient. These Tumor Boards are often an expert team with a pathologist, an oncologist, surgeon, and a radiation oncologist. All Tumor Boards should be creating Treatment Scores and publishing them for public peer review. This would take medicine out of the dark ages and into the light as the patient would finally be able to see what is happening in the real world. </div><h1 style="text-align: left;">Medical Research </h1><div>Medical research should be based on Treatment Scores. Right now, the way money is given to the National Institutes of Health is very political. There are hearings and those who scream the loudest and obtain the most political power are often the ones who get the money. If we had Treatment Scores for everything, we could go down the line and fund the deadliest or most disabling diseases that have treatments with the lowest Treatment Scores. There could be more logic to the process. We could also identify where private industry needs to innovate. </div><h1 style="text-align: left;">Roll Back Regulations </h1><div>We need to make physicians scientists again. We need to roll back the regulations that prevent physicians from having a microscope! All primary care physicians need a laboratory and the tools to do ethical clinical research. Especially research on things like Treatment Scores. All primary care physicians should be calculating Treatment Scores before treatment, and should also be getting follow-up Treatment Scores after treatment. </div><h1 style="text-align: left;">“Doctor, what would you do?” </h1><div>What the patient typically wants to know, and needs to know, is the answer to the age-old question, “Doctor, what would you do if it were you?” I heard this question asked by patients many times during medical school and residency to my attending physicians. It has been asked of me many times. </div><div><br /></div><div>This question by patients really gets to the heart of the matter. If your doctor drops all biases, conventional wisdom, and ignores what is commonly done because it’s always been done, and focuses on what they would do for themselves after calculating Treatment Scores, what would it be? It would often be something different than what you get. </div><div><br /></div><div>Getting the answer to “Doctor what would you do?” gets you to step 2 of evidence-based medicine. Then, the doctor and patient need to sit down and do step 3 of evidence-based medicine, the patient’s values and preferences, to get the final Treatment Score. </div><h1 style="text-align: left;">Who’s Looking over Your Doctor’s Shoulder? </h1><div>Anesthesiologists have surgeons looking at their work every day all day long. Emergency Medicine physicians have their work reviewed every time they refer a patient on to another physician. The same for Family Medicine physicians.
But who is looking over the shoulder of your urologist? Your neurosurgeon? Your endocrinologist? Often, no one independent of their specialty is checking if what they do is scientific and logical. </div><div><br /></div><div>Treatment Scores fixes that. Treatment Scores create “public peer review” and allow other doctors, and all patients, to review the science and logic behind medical treatments. This kind of medical transparency is priceless and badly needed—yesterday. </div><div><br /></div><div>Family Medicine physicians, Emergency Medicine physicians, Pediatricians, and all primary care specialties should be reviewing and critiquing the Treatment Scores done by the urologists, neurosurgeons, oncologists, and endocrinologists. They should be checking the Treatment Scores of the physicians they refer patients to. And, instead of referring patients based on hospital rotations (politics) as is done now, they should refer patients based on the best treatment available according to Treatment Scores, regardless of the specialty. For example, every prostate problem is sent to a urologist, because they “own” that organ. Yet, the best treatment and the highest Treatment Score for a specific patient might be with an oncologist who does active surveillance. </div><div><br /></div><div>We need to complete the circle of quality control. It should not be a straight line from primary care to specialists. It should be a circle from primary care to specialists and back to primary care. There needs to be a Family Medicine revolution. </div><h1 style="text-align: left;">Quality Control Example </h1><div>There is a great example in medicine where a surgeon claims the surgery that he does for cancer has a 90% cure rate. Looking at the exact same data, physicians, who don’t do the surgery, in other specialties think the operation has a 10% or less Treatment Score. Furthermore, this debate has been going on for 22 years without the data changing significantly, because the newer studies also show the 10% or less Treatment Score. But most of the world cannot understand this situation, because the data is not transparent. If this data were organized and summarized into a Treatment Score, far more people would understand that the surgeon is including patients that don’t need to be cured in his data, while the other physicians only include patients that need to be cured from this slow-growing cancer. </div><div><br /></div><div>This is why having different specialties doing Treatment Scores will be so important. It removes bias. If the specialty of surgery does a Treatment Score and it is very high, and the specialty of anesthesiology does a Treatment Score for the same treatment and it is very low, there is a problem! This kind of quality control reveals bias, bad data, missing data, or some other problem. Patients need to know this information! </div><h1 style="text-align: left;">Public Peer Review </h1><div>Treatment Scores create the ability to do “public peer review” and to teach patients how physicians think when they use science and logic. Logic starts at the beginning. What is the highest quality, most relevant study, for the diagnosis and treatment being studied? That’s where Treatment Scores start.</div><h1 style="text-align: left;">Follow-Up After Treatment </h1><div>Patients, using shared decision-making with their physician, are given the expected Treatment Scores before treatment. After treatment, we should follow-up with the actual Treatment Score with the patient reporting their actual outcome, actual side effects suffered, and actual side benefits. This is the perfect universal way to collect pre- and post-treatment data. Giving the patient the “expected” Treatment Score beforehand, and the patient giving the “actual” Treatment Score obtained after treatment. Over time the gap between “expected outcomes” and “actual outcomes” should start to narrow. </div><div><br /></div><div>Treatment Scores should become the universal system for treatment transparency before treatment and for follow-up after treatment. </div><h1 style="text-align: left;">Follow the Headlines </h1><div>Once Treatment Scores gets going, they will get free publicity. For example, COVID19 is dominating the news. We can calculate Treatment Scores for that!
What if the diagnosis is “preventing COVID19 in the average person?” And, the treatment list is: </div><div><ul style="text-align: left;"><li>Wearing a surgeon’s mask </li><li>Wearing a cloth mask </li><li>Or taking the triple therapy of hydroxychloroquine, zinc, and or azithromycin as prophylaxis. </li></ul></div><div>There’s a Treatment Score for all these treatments that can be put up for public peer review. And, it depends on the patient what the most important outcome measure is for them. One might start with 5-year overall survival as an outcome measure. If studies cannot be found using that outcome measure, another outcome measure would have to be chosen. </div><div><br /></div><div>If a 6-year-old kid is sent to school wearing a surgeon’s mask all day long for one year because of COVID19, how much would it increase or decrease their 1-year overall survival? This would be an important Treatment Score to calculate. But when we dig into it, we may not have the needed studies, so we may have to use a more available main outcome measure. We will have to find the most relevant studies and the highest quality studies. Once Treatment Scores get started, they can make headlines every week by jumping on the major healthcare news story of the week and publishing Treatment Scores. </div><h1 style="text-align: left;">Questions we need to Answer </h1><div>Treatment Scores could give quantified answers to all of these questions, and put them up for public peer review. Treatment Scores would also allow each question to be answered with personalized and individualized medicine, which has long been the goal. </div><div><ul style="text-align: left;"><li>Should you wear a cloth mask to prevent getting or spreading COVID-19? </li><li>Should you make your child wear a mask all day long every day at school? </li><li>If you get COVID-19, should you take remdesivir? </li><li>If you get COVID-19, should you take hydroxychloroquine + azithromycin + zinc? </li><li>If you get COVID-19, should you take steroids via an inhaler? </li><li>If you get COVID-19, should you take steroids as intravenous dexamethasone? </li></ul></div><div>As you can see from looking at the world today, we can’t even organize the medical literature into the highest quality and most relevant studies for any clinical question for the public, patients, doctors, and nurses. Treatment Scores would fix all that. </div><div><br /></div><div>What is the single best study to answer each of these COVID-19 questions? Logic says we need to start at the beginning, at the single best and most relevant study. Where is that study? What does it say? Why don’t you know after all these months of a lethal pandemic? </div><h1 style="text-align: left;">Obstacles to Moneyball for Medicine </h1><div>1. Apathy. Most people are not sick most of the time, and most people don’t want to think about getting sick. This creates a great deal of apathy. However, the healthcare industry is a 7-trillion-dollar industry worldwide, so it is tremendously significant. Demand will change. Once patients can look up a list of treatments with Treatment Scores for the common cold, they will want to be able to do it all the time for all diseases, and they will be surprised by what they find. </div><div><br /></div><div>2. Quantification is a sea change. We have to turn the Titanic to create treatment transparency and it will require momentum. At first the status quo in Academia, Government, and Industry will resist this change, they already have. </div><div><br /></div><div>3. Time. Treatment Scores will take an enormous amount of time by highly intelligent physicians and programmers at first, but will get faster and easier with time as the system is built. </div><div><br /></div><div>4. Health illiteracy. Most patients are health illiterate. And, as my physician colleague, a Family Medicine physician said to me, “They are also just plain math illiterate.” We need patients to demand Treatment Scores. There are 57 treatments in the medical literature for an acute migraine headache. Why don’t we have a list of all 57 treatments with a Treatment Score for each one? One reason is that patients don’t demand better treatment transparency. Patients don’t know that they need to demand this type of organization and quantification with Treatment Scores, but eventually they will. You are the agent of change. </div><div><br /></div><div>5. Most doctors are not hard scientists, and most doctors, according to studies, are not very good at medical statistics. </div><div><br /></div><div>6. The status quo. It is hard to improve healthcare, because the current third parties are making money hand over foot and are enjoying incredible power far beyond what they deserve. Data science has not done its job. Medical informatics has not done its job. Continuing Medical Education (CME) should be all about Treatment Scores. Bill James invented Sabermetrics for baseball, which led to the book and movie, Moneyball, and the entire process of invention to adoption, leading to a World Series victory, took 20 or 30 years. </div><div><br /></div><div><b>Ethics</b>. Why haven’t Treatment Scores for every medical treatment been done yet? Some have been done, but another hurdle is ethics. To produce Treatment Scores, we need doctors that want to put the patient first. We need doctors that want to end the information monopoly that exists now, where physicians know everything (or a lot) and patients know next to nothing. Patients need transparency: both price transparency and product transparency. When you translate product transparency from economic terminology into medical terminology, you get “treatment transparency.” </div><div><br /></div><div><b>Ethics in business</b>. We also need business people that want to do the right thing. There is so much secrecy in medicine now, things hidden from patients, that the system makes out like a bandit from secret monopolies. The people making excess money from secrecy don’t want to see the system changed. </div><div><br /></div><div><b>Brain power</b>. The first time Treatment Scores are done for any diagnosis, it takes a lot of brainpower and time by human beings, because you have to start with a systematic review and meta-analysis of the literature, which according to one study takes on average, 5 people working for 67.3 weeks (Borah). However, once the Treatment Score is done the first time, computers come into play, and algorithms can be used to constantly keep the Treatment Score up to date, and crowd wisdom can be used to keep checking for problems in the data. Time is also saved because once done, a good Treatment Score does not change much over time. I calculated a Treatment Score of less than 10% in 1998 for a certain surgery, and that Treatment Score has not changed in 22 years. This is because once a really good randomized controlled trial proves something, future good studies reinforce that finding—they don’t change it. </div><div><br /></div><div><b>Salaries</b>. To get Treatment Scores going, one would need to hire a super smart, logical, and creative physician away from their already highly paying job, and would need to hire an excellent, already highly paid programmer, who hopefully is a physician as well (yes, a few of them exist), and then be able to pay them for years to develop Treatment Scores. </div><div><br /></div><div><b>Revenue Streams</b>. An incredibly user-friendly smart phone app would need to be created that would be so simple that all physicians and all patients could use it. Revenue streams would have to be created. Since Treatment Scores would steer everyone in the healthcare system to treatments that tend to work, and away from treatments that are highly questionable, this would lower costs in the entire healthcare system. Treatment Scores would also make it apparent when two medical treatments have the same outcome for patients, yet one costs 1 million dollars while the other treatment only costs $10,000. </div><div><br /></div><div>After Treatment Scores get going, the backend can be infused with artificial intelligence, which will automate things more and more until the entire process of 10,000 variables becomes incredibly fast. </div><div><br /></div><div>We all need to insist that medical studies be more machine-reader friendly! Natural search engine technology is doing this for us, but the publishers need to start doing it. We need to be able to find the best studies more easily, so they need to be better labeled. In addition, I often find a data point that I need in a study, but I have to calculate it by hand, because the authors don’t place enough importance on this finding in their own data. </div><h1 style="text-align: left;">Treatment Scores will Happen </h1><div>Quantification of medical treatments will happen. Treatment Scores have to happen, because they will improve healthcare by leaps and bounds. I think we will look back one day and see the quantification of healthcare with Treatment Scores as being more important than the invention of Penicillin. The good of penicillin has mostly come and gone as bacteria have developed resistance to it, and because many other antibiotics have been invented that can be used instead. However, the good of Treatment Scores to organize and quantify medical treatments (and all clinical decisions) will go on forever. </div><div><br /></div><div>Someday, a simple Treatment Scores smart phone app is going to change everything about healthcare by shining a light into the darkness. </div><h1 style="text-align: left;">What Should Drive Treatment Scores </h1><div>1. Better patient outcomes. Treatment Scores will solve the problems of health illiteracy, undertreatment, and overtreatment. Because Treatment Scores measure value as determined by the patient, not some uncaring third party, patient care can be improved for the patient. Treatment Scores will mean better patient care at a better price, because less money will be wasted. </div><div><br /></div><div>2. Passion & Panic. When people do get sick, they are often consumed with passion to get well. They spend boundless time and energy trying to get better. This is the time, if patients realize how Treatment Scores work, that they will desperately want them. Patients may have to drive Treatment Scores. A patient may get sick with colon cancer, breast cancer, or prostate cancer and may passionately want to know the list of treatments and Treatment Scores. Perhaps a start-up company will provide them for the patient on their smart phone. That patient then needs to be able to share that same list of treatments with Treatment Scores with their physician so they can do steps 2 (physician expertise) and step 3 (the patient’s values and preferences) of evidence-based medicine. </div><div><br /></div><div>3. Desire to help people. Most doctors truly want to help people. They can maximize the good they can do with Treatment Scores. When doctors understand what Treatment Scores can do for them, they will want them. </div><div><br /></div><div>4. Healthcare is going broke. Treatment Scores can lower costs and improve care simultaneously, and for all parties in healthcare, patients, doctors, nurses, allied healthcare professionals, hospitals, insurance companies, and governments. </div><div><br /></div><div>5. Non-profits. My friend got a particular kind of breast cancer. It was not my area of expertise, so I called a breast cancer non-profit. I said, “The patient has stage 4 breast cancer with these other markers and characteristics. What are the treatments that should be on the list of treatments for this?” Dead silence. I was incredibly polite, but ended up being met with hostility. We need to change it so non-profits can be curators of a list of treatments with Treatment Scores. Most of them have physicians and highly, highly intelligent patients they work with. Non-profits should be able to curate a list of treatments with Treatment Scores and give the simple disclaimer, “We do not recommend any specific treatment, but when we do the math for ourselves, we get this.” This inside knowledge should not be hidden from patients. </div><h1 style="text-align: left;">How to get Started </h1><div>A super simple and easy smart phone app needs to be created. That’s going to take a programmer, hopefully a physician programmer, who can work with at least one physician who knows how to create Treatment Scores. So, right off the bat, there needs to be salaries for at least two brilliant people, who already have salaries that would be difficult to give up. Because of COVID-19 these people probably need to work at home, so the entire system of doing Treatment Scores, conferences, and teaching should probably be set up as telemedicine/videoconferencing from the beginning. </div><h1 style="text-align: left;">Licensing </h1><div>The people most interested in Treatment Scores right now are the patients smart enough to understand the entire concept. But once a large group of patients understands Treatment Scores, there will be a large demand for them. There should be a revenue stream created by producing a yearly book of Treatment Scores for all diseases and all treatments, and those scores can be tied to reimbursement, and done so fairly, because the scores are produced with input by the patients themselves. The licensing fees for using such a database for reimbursement should be astronomical, because Treatment Scores are much more important than many other medical codes that are licensed. After all, treating patients to make them better is the main point of healthcare. </div><div><br /></div><div>Change will occur. Understandable treatment transparency, quantified, for the patient is too good of an idea to ignore forever. One day, Treatment Scores will change the world. The good of knowing the “expected net treatment benefit for the patient” cannot be denied. </div><h1 style="text-align: left;">Spokesperson </h1><div>The ability of Treatment Scores to ride the wave of every health-related news cycle means that Treatment Scores must have a great spokesperson for the media. As I am fond of saying, “People don’t believe statistics; people believe people who can explain statistics.” </div><h1 style="text-align: left;">Who Needs Treatment Scores? </h1><div>Who needs Treatment Scores? Patients, doctors, nurses, all allied healthcare professionals, all medical schools, all medical residency programs, all hospitals, and all medical research entities. Pretty much everyone needs Treatment Scores at some point including all insurance companies and governments.</div><div><br /></div><div>Perhaps there will be a start-up that uses independent physicians to calculate Treatment Scores. Patients will want these Treatment Scores once they understand them, because their life is at risk, and their health is at risk, and they need a trusted source of information. COVID19 has taught us that this work can be done remotely. Telemedicine/video-medicine is great for Treatment Scores. </div><div><br /></div><div>Perhaps a business will start-up to do Journal Clubs remotely for all medical residency programs. All resident physicians should be doing Treatment Scores. Why not create the app so that they can actually do them? Why not collect all that data and start improving treatment transparency and start doing better quality improvement in healthcare? We need to solve health illiteracy and we need better patient care.
</div><div><br /></div><div>Every physician should carry on their cell phone a list of treatments with Treatment Scores for all the diagnoses that they deal with most often. Algorithms should help the physician keep the Treatment Scores up to date. An alert should be sent out when a good study changes a Treatment Score. It should not take years and years to filter through the medical system. The sick patient should have the same list of treatments with Treatment Scores on their cell phone so that they can be their own best healthcare advocate. We could have individualized medicine, because every individual’s tolerance for risk is different and medicine needs to be personalized. Treatment Scores will:</div><div><ul style="text-align: left;"><li>Put the patient first </li><li>Improve patient care </li><li>Decrease costs </li><li>Enable true value-based healthcare using patient preferences </li><li>Improve treatment transparency
• Help solve health illiteracy </li><li>Save time for patients, doctors, and nurses </li><li>Make your smart phone even more important for healthcare. </li></ul></div><h1 style="text-align: left;">References: </h1><div>Bruce Ramshaw, MD. “Moneyball for Health Care: Why Hasn’t it Happened?” General Surgery News (July 29, 2020). This article also appeared in Healthcare: Systems Science (August 17th, 2020). </div><div><br /></div><div>Rohit Borah, Andrew W Brown, Patrice L Capers, Kathryn A Kaiser. “Analysis of the time and workers needed to conduct systematic reviews of medical interventions using data from the PROSPERO registry.” BMJ Open. October 25, 2016. https://bmjopen.bmj.com/content/7/2/e012545. Accessed September 10, 2020. </div><div><br /></div><div>PanCAN. Quote: “The Pancreatic Cancer Action Network strongly recommends clinical trials at diagnosis and during every treatment decision.”
https://www.pancan.org/facing-pancreatic-cancer/treatment/treatment-types/clinical-trials/ Accessed: September 9th, 2020. </div><div><br /></div><div>Johns Hopkins Medicine. “Pancreatic Cancer Prognosis: Stage IV Prognosis.”
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-prognosis
Accessed September 9, 2020. </div><div><br /></div><div>Chul Kim, MD, MPH and Vinay Prasad, MD, MPH. “Cancer Drugs Approved on the Basis of a Surrogate End Point and Subsequent Overall Survival: An Analysis of 5 Years of US Food and Drug Administration Approvals.”
JAMA Intern Med. 2015;175(12):1992-1994. Doi:10.1001/jamainternmed.2015.5868
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2463590
Accessed: September 1, 2020. </div><div><br /></div><div>John P.A. Ioannides, M.D., DSc. "Why most published research findings are false." PLoS Med. 2005 Aug;2(8):e124. doi: 10.1371/journal.pmed.0020124. Epub 2005 Aug 30.
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 Accessed: September 8st, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/ </div><div><br /></div><div>Jacob Sullum. “America's War on Pain Pills Is Killing Addicts and Leaving Patients in Agony.” The government's efforts to get between people and the drugs they want have not prevented drug use, but they have made it more dangerous. Reason. April 2018 issue. <a href="https://reason.com/2018/03/08/americas-war-on-pain-pills-is/">https://reason.com/2018/03/08/americas-war-on-pain-pills-is/</a> Accessed: September 16, 2020. </div><div><br /></div><div>Steve Jobs. Quote: “You've got to start with the customer experience and work back toward the technology - not the other way around.” May 1997, World Wide Developers Conference. </div><div><br /></div><div><div>WebMD. "498 medications found for insomnia."</div><div><a href="https://www.webmd.com/drugs/2/condition-3063/chronic%20trouble%20sleeping">https://www.webmd.com/drugs/2/condition-3063/chronic%20trouble%20sleeping</a></div><div>Accessed September 19, 2020.</div></div><h1 style="text-align: left;">URLs about Steve Jobs: </h1><div>https://sciencebasedmedicine.org/one-more-thing/
</div><div><br /></div><div>https://fortune.com/2008/03/05/the-trouble-with-steve-jobs/
</div><div><br /></div><div>https://healthland.time.com/2011/10/05/the-pancreatic-cancer-that-killed-steve-jobs/
</div><div><br /></div><div>https://www.nytimes.com/2011/11/01/health/hindsight-is-kind-to-steve-jobss-decision-to-delay-surgery.html
</div><div><br /></div><div>https://www.livescience.com/16551-steve-jobs-alternative-medicine-pancreatic-cancer-treatment.html
</div><div><br /></div><div>https://www.nytimes.com/2011/10/21/technology/book-offers-new-details-of-jobs-cancer-fight.html
</div><div><br /></div><div>https://www.thedailybeast.com/steve-jobs-dies-his-unorthodox-treatment-for-neuroendocrine-cancer
</div><div><br /></div><div>https://alternativemedicine.com/alternative-medicine/departments/did-alternative-medicine-kill-steve-jobs (This URL may not be active.) </div><div><br /></div><div><b>CONTACT: </b></div><div>Dr.Hennenfent [at] gmail.com</div>BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-64050578649345559142019-06-27T14:58:00.000-04:002019-06-27T14:58:06.074-04:00Got cancer? Here's how to think it through. Put the patient first.Got cancer? Here's how to think it through. Put the patient first and figure out the Net Treatment Benefit for the patient. There is an 88% health illiteracy rate (Health.gov). Patients literally do not understand their medical treatments.<br />
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“Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.” - PCORI<br />
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We need to translate “…existing scientific research into accessible and useable [sic] formats….” - PCORI<br />
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Download this document, which teaches you how to calculate the Net Treatment Benefit for the patient:<br />
<a href="https://drive.google.com/file/d/1o1eoBZwPadJV_HpVZlk9KrH0vfzOBNZC/view?usp=sharing">https://drive.google.com/file/d/1o1eoBZwPadJV_HpVZlk9KrH0vfzOBNZC/view?usp=sharing</a><br />
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PCORI = Patient-Centered Outcomes, Research Institute, Funding Announcement: Communication and Dissemination. Published May 22, 2012. Revised September 17, 2012. Accessed June 22, 2019.<br />
http://www.pcori.org/assets/FINAL-PFA-Communication-and-Dissemination-v3.pdf<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoIFnQo81aO-UX7YOXqgA-RNIBE0gJpK9rTnUtntyTt2k3FENNqrGiqMBY38mAT64lEueAG_ATZUcku0zUZLHw7LtDyU1nUvRPCbgD-8smqvqS0syMV9skK4NukKsuJLz5Wn4NjJ_euLQ/s1600/got+cancer2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="335" data-original-width="600" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoIFnQo81aO-UX7YOXqgA-RNIBE0gJpK9rTnUtntyTt2k3FENNqrGiqMBY38mAT64lEueAG_ATZUcku0zUZLHw7LtDyU1nUvRPCbgD-8smqvqS0syMV9skK4NukKsuJLz5Wn4NjJ_euLQ/s320/got+cancer2.png" width="320" /></a></div>
<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-61112596570546188922019-04-29T14:39:00.001-04:002019-04-29T14:46:14.605-04:00The Science of Medicine SOM® is Not the Same as Evidence-Based Medicine <div style="line-height: 1.38; margin-bottom: 6pt; margin-top: 20pt;">
The Science of Medicine SOM® is based on medical studies alone, and is an attempt to understand what the best medical studies say without the information being filtered through the potentially biased eyes of human beings.<br />
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The Science of Medicine SOM® is the first step of evidence-based medicine. Two people can read the same medical study and interpret it differently. So, the Science of Medicine SOM® is about the hardest data from experimental studies such as randomized controlled trials (if they exist). Experimental studies are hard science while observational studies are soft science.<br />
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Evidence-based medicine has three parts:<br />
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<ol>
<li>Medical studies</li>
<li>Clinical Experience</li>
<li>Values and preferences of the patient</li>
</ol>
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You can also write the three steps of evidence-based medicine this way:<br />
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<ol>
<li>The Science of Medicine SOM®</li>
<li>Clinical experience</li>
<li>Values and preferences of the patient </li>
</ol>
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COPYRIGHT<br />
Copyright © Treatment Scores, LLC. All Rights reserved.</div>
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<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-83391964628617675602019-04-07T12:43:00.000-04:002019-05-25T09:44:06.485-04:00Listen to the Patient!What is the "Net Treatment Benefit for the Patient?" Remember, the first rule of medical ethics, FIRST DO NO HARM! Figure out the "Net Treatment Benefit" for the patient before and after treatment.<br />
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Here is a Treatment Score Calculator™ for patients, doctors, nurses, and everyone else, that you can print or download. It is a simple, easy way to understand the concept of the "Net Treatment Benefit for the Patient" using chronic pain as an example.<br />
<a href="http://tinyurl.com/y2r7gtbl">http://tinyurl.com/y2r7gtbl</a><br />
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The patient who takes Tylenol®, Motrin®, Naprosyn®, or hydrocodone will almost never receive the same "Net Treatment Benefit" from these medicationss. The treatment effects are different and side effects are different. In addition, every patient reacts differently to medications!<br />
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The Universal Treatment Score Calculator™ at the end of the document can be used to educate yourself about any treatment for any disease:<br />
<a href="http://tinyurl.com/y2r7gtbl">http://tinyurl.com/y2r7gtbl</a><br />
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Let's institute these medical principles:<br />
<ul>
<li>Patient empowerment </li>
<li>Transparency </li>
<li>Informed consent </li>
<li>Patient autonomy </li>
<li>Shared decision-making </li>
<li>Evidence-based medicine</li>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-48942478516061473572019-04-01T14:52:00.000-04:002019-04-01T14:52:27.035-04:00Treatment Score Calculator(TM) - Chronic Pain ExampleWhat the patient most needs to know is the "net treatment benefit" for them. When anyone gets sick they need a list of treatments with Treatment Scores.<br />
<br />
The Treatment Score = the net treatment benefit for the patient.<br />
<br />
This is the simplest example of how to calculate the "net treatment benefit for the patient" that we have come up with so far. You can print or download the Treatment Score Calculator(TM) - Chronic Pain Example here:<br />
<br />
<a href="https://tinyurl.com/y24tzpw3">https://tinyurl.com/y24tzpw3</a><br />
<br />
This example also includes a Treatment Score Calculator(TM) that can be used for any treatment for any disease.<br />
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ALWAYS SEE YOUR OWN LICENSED MEDICAL DOCTOR FOR DIAGNOSIS, TREATMENT, AND MEDICAL STATISTICS, INCLUDING TREATMENT SCORES.BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-26686283091195460842019-03-21T09:33:00.001-04:002019-03-22T10:14:38.721-04:00The Net Treatment Benefit for the PatientTreatment Scores, LLC suggests that the patient needs to know the "net treatment benefit for the patient" before treatment, and that the patient needs to report the "net treatment benefit for the patient" to the physician after treatment.<br />
<br />
We also call the "net treatment benefit for the patient" the Treatment Score.<br />
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We believe that when anyone gets sick, they need a list of treatments with Treatment Scores. This information should come from patients and doctors working together doing evidence-based medicine and shared decision-making.<br />
<br />
There is an 88% health illiteracy rate (Health.gov) and we should reduce health illiteracy with education.BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-47916116256936364592019-03-07T08:51:00.002-05:002019-03-07T08:51:55.430-05:00Pay Treatment Scores, LLC with BitcoinPay Treatment Scores, LLC with Bitcoin<br />
<br />
<form action="https://bitpay.com/checkout" method="post" >
<input type="hidden" name="action" value="checkout" />
<input type="hidden" name="posData" value="" />
<input type="hidden" name="data" value="SoCLQB57X+Noje6O9lmGPapWwHF+ScU/yMMcqJkBs7oToWbTysqhM2j6Yoig716n3r/Y77yuG5RQocdD0Hbv49taVOMjErrVCZ8or2CpzjER4G/PA/gO8D85KdLr/glQevn4d9/rGXjE7dvXAORNFc72qa0I6k6/D+v+7PGdNYLLTQ3xHjTTwjZxZok68C0s/KdBXIFHZ8YH40qekvL9YA==" />
<input type="image" src="https://bitpay.com/cdn/en_US/bp-btn-pay-currencies.svg" name="submit" style="width:168px;" alt="BitPay, the easy way to pay with bitcoins." >
</form>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-52273777202418693372019-01-17T08:48:00.000-05:002019-01-17T08:48:06.055-05:00Solving Worldwide Health Illiteracy with the Science of Medicine, SOM®The first step in solving Worldwide Health illiteracy is learning the Science of Medicine, SOM®. What is the Science of Medicine? The Science of Medicine is the most objective part of the existing medical knowledge; the part most free of human bias and conflicts of interest.<br />
<br />
The Science of Medicine SOM® is derived from statistics within the medical literature. For example, how much does a particular chemotherapy increase your 5-year overall survival according to the best study done so far?<br />
<br />
Evidence-Based Medicine has three steps:<br />
<br />
1. The Science of Medicine SOM®<br />
2. The knowledge of the physician<br />
3. The values and preferences of the patient<br />
<br />
What patients, doctors, nurses, and others need is an online database of the Science of Medicine, SOM®. It's very difficult to review and summarize the over 29 million medical articles on Medline. We should have an online, and offline, database that does it for us.<br />
<br />
We need a list of treatments with Treatment Scores for everything. We need an online database of what we actually know and don't know, and it needs to be quantified. We need a database about the medical literature, about the gross and net treatment benefit of medical treatments, and also about hypotheses regarding medical treatments.<br />
<br />
I saw a commercial on TV for a drug called Harvoni. It is used to treat hepatitis C. Interestingly, by narrowing down the diagnosis to a more specific diagnosis, and by only reviewing randomized controlled trials, I found the gross treatment benefit for Harvoni to be 95%, as in a 95% cure rate at three months. This is impressive as the old interferon-based treatment for hepatitis C only had a Treatment Score of about 40, or 40%. Harvoni appears to be at least twice as good as the old treatment.<br />
<br />
Healthcare should be this simple. You get a diagnosis. Then, you get a list of treatments with Treatment Scores for that diagnosis.<br />
<br />
<b>DISCLAIMERS</b>: I have nothing to do with Harvoni and don't get paid by Harvoni. Always see your own physician for diagnosis and treatment. We do not give medical advice and we do not form patient-doctor relationships.<br />
<br />
Bradley Hennenfent, M.D.<br />
@BradMD on Twitter<br />
<br />
Copyright (C) 2019. Treatment Scores, LLC<br />
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<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-54218369210473469312018-12-16T09:19:00.002-05:002018-12-16T09:19:25.665-05:00EBM® Easy Basic Math is Needed in Healthcare<span style="font-family: Trebuchet MS, Trebuchet, Verdana, sans-serif;"><b>EBM® Easy Basic Math is Needed in Healthcare</b></span><br />
<span style="background-color: white;"><span style="font-family: inherit;">by BradMD</span></span><br />
<span style="background-color: white;"><span style="font-family: inherit;">(Brad Hennenfent, MD)</span></span><br />
<br />
<br />
<br />
There is an 88% health illiteracy rate according to Health.gov. How can patients understand healthcare better? I believe much of the health illiteracy problem is connected to the math illiteracy problem. <span style="font-family: inherit;"> </span><br />
<br />
<span style="font-family: inherit;"><br style="background-color: white;" /></span>
<span style="font-family: inherit;"><span style="background-color: white;">A 2008 medical article defines evidence-based medicine as:</span></span><br />
<span style="font-family: inherit;"><br style="background-color: white;" /><span style="background-color: white;">"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."</span><span style="background-color: white;">SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white;">This means we need to combine the mathematics of three things for patients:</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white;">1. Statistics from the medical literature</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white;">2. Adjustments to those statistics based on the values and preferences of the physician</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white;">2. Further adjustments to those statistics based upon the values and preferences of the patient.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white;">Copyright (c) 2018. All rights reserved.</span></span><br />
BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-38465282649317426542018-11-29T08:57:00.001-05:002018-11-29T08:57:19.423-05:00The Science of Medicine - SOM®<b>The Science of Medicine - SOM®</b><br />
by BradMD<br />
(Brad Hennenfent, MD)<br />
<br />
What is the science of medicine?<br />
<br />
The science of medicine is the first step of evidence-based medicine. So, What is evidence-based medicine?<br />
<br />
Evidence-based medicine consists of three things.<br />
<br />
1. What the science says<br />
2. What the physician knows<br />
3. What the patient wants<br />
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I have summarized my simple definition of evidence-based medicine partly from a complicated 2008 medical article, which defines evidence-based medicine as:<br />
<br />
"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."<br />
SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/<br />
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You can see that this "Masic, Miokovic, and Muhamedagic" definition combines three things:<br />
<br />
1. best evidence<br />
2. clinical experience<br />
3. patient values and preferences<br />
<br />
What makes it confusing is that there are three terms:<br />
<br />
1. Science-based medicine<br />
2. Evidence-based medicine<br />
3. Evidence-based practice<br />
<br />
These terms are defined differently in different places and during different times in medical history. Most people would probably be surprised at the range of definitions and controversies surrounding evidence-based medicine.<br />
<br />
Gordan Guyatt, MD, from McMaster University is credited with inventing the term "evidence-based medicine" and publishing it in 1991.<br />
SOURCE: Guyatt GH. Evidence-Based Medicine [editorial]. ACP Journal Club 1991:A-16. (Annals of Internal Medicine; vol. 114, suppl. 2).<br />
<br />
One website says: "Dr. Gordon Guyatt from McMaster University, who coined the term 'evidence-based medicine'...."<br />
SOURCE: UpToDate. Accessed 11-28-2018. https://www.uptodate.com/home/editorial<br />
<br />
The McMaster University website, in an article written by Gordon Guyatt, MD, says:<br />
<br />
"What are the defining principles of EBM?<br />
"EBM describes a set of practices to help solve clinical problems<br />
"Essentially, EBM encourages physicians to use the best available evidence to inform clinical decisions<br />
"Evidence takes the form of published literature, or unpublished personal observations"<br />
<br />
SOURCE: Gordon Guyatt. Evidence-based Medicine. McMaster University Website. Accessed 11-28-2018.<br />
https://www.mcmaster.ca/cfh/ktebm.html<br />
<br />
Note, that in the original Gordon Guyatt - McMaster University definition of evidence-based medicine, the patient was left out of the decision-making process. Gordon Guyatt, and McMaster University defined evidence-based medicine as only two things:<br />
<br />
1. Best available evidence<br />
2. Unpublished personal overservations<br />
<br />
The patient was left out of EBM in the beginning, and medicine remained paternalistic. The doctor told you what was best, based on what the doctor thought was the best evidence and based upon the doctor's unpublished personal observations.<br />
<br />
Today, because of the transparency of information brought about by the Internet, many patients, patient groups, doctors, and nurses are trying to end paternalistic medicine and move medicine, the science of medicine, evidence-based medicine, or evidence-based practice, into a process of shared decision-making so that the patient is never left behind. In medical ethics, this is part of the principle of "patient autonomy."BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-18287498864257852972018-08-13T09:03:00.001-04:002018-08-13T09:08:23.679-04:00Problems - Medical Treatments - Treatment Scores<iframe allowfullscreen="" frameborder="0" height="270" src="https://www.youtube.com/embed/ymJVwiFDxD0" width="480"></iframe><br />
<br />
This short video describes how patients and physicians should be doing evidence-based medicine and shared decision-making together, calculating the Net Treatment Benefit for the patient. The direct URL is: <a href="https://youtu.be/ymJVwiFDxD0">https://youtu.be/ymJVwiFDxD0</a><br />
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When you get sick with any illness you need a list of treatments with Treatment Scores. The Treatment Score = the net treatment benefit for the patient.<br />
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The Treatment Score is calculated using EBM guidelines and shared decision-making. Treatment Scores solve health illiteracy while taking into account the values and preferences of individual patients.<br />
<br />
Together you use the:<br />
<ol>
<li>Outcome measure important to the patient</li>
<li>Time scale important to the patient, and</li>
<li>Absolute outcome measures not relative outcome measures</li>
</ol>
DISCLAIMER: Always see your own licensed medical physician for diagnosis and treatment. Treatment Scores are an organizational tool only.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-9637495302114208342018-06-26T08:33:00.001-04:002018-06-26T08:33:33.420-04:00Treatment Scores Solve Problems<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">Dr. Kit Byatt and Sarah Chapman recently published an article titled, "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." </span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">It's an excellent article about what patients, doctors, and healthcare journalists need, so let's offer a solution.</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFJ9L4ya5czZLZg4qfJB7ETvjB4xnUIU2vkQYlSzj3Z2FMo2MgJMWoGJ9CkzbDS7VLZE26MA3Y2f3fvMvz-2GaY8TXP3j4x1D2uClDSZIdvjWqAemvXUVV32kgg3EU3NZ3Cednp7P2aV4/s1600/border+300x300x96+1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFJ9L4ya5czZLZg4qfJB7ETvjB4xnUIU2vkQYlSzj3Z2FMo2MgJMWoGJ9CkzbDS7VLZE26MA3Y2f3fvMvz-2GaY8TXP3j4x1D2uClDSZIdvjWqAemvXUVV32kgg3EU3NZ3Cednp7P2aV4/s1600/border+300x300x96+1.png" /></a></div>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span>
<span style="background-color: white; color: #333333; font-family: "Source Sans Pro", "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif;">The authors want certain things when it comes to medical information. They see problems. To quote from them:</span><br />
<br />
<ul>
<li>"Offer people information about their absolute risk of...absolute benefits and harms of an intervention...."</li>
</ul>
<br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">"This information should be in a form that:</span></span><br />
<br />
<ul>
<li>"presents individualised risk and benefit scenarios and</li>
<li>"presents the absolute risk of events numerically and</li>
<li>"uses appropriate diagrams and text."</li>
</ul>
<br />
<span style="background-color: white; color: #333333; font-family: "Source Sans Pro", "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif;">Treatment Scores solve the problems listed in this article. The Treatment Score = the net treatment benefit for the patient. </span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">Furthermore, the Treatment Score = the net treatment benefit for the patient using evidence-based medicine guidelines and shared decision-making. In other words, Treatment Scores make the medical literature simple and understandable for patients, doctors, and healthcare reporters using absolute outcome measures. Treatment Scores also allow for the values and preferences of patients to be taken into account.</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">What patients need, and what physicians and healthcare journalists need to report is a list of treatments with Treatment Scores for every disease. Treatment Scores would be the starting point for shared decision-making because of the chain of visual aids behind them that make them clear, understandable, and adaptable to patient input.</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">REFERENCE:</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">Kit Byatt and Sarah Chapman. "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." Evidently Cochrane. April 26, 2018.</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;">http://www.evidentlycochrane.net/being-patient-with-ebm-supporting-informed-decision-making/</span></span><br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;">DISCLAIMERS:</span><br />
<span style="color: #333333; font-family: "Source Sans Pro", "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif;">You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for informational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.</span><br />
<br />
<span style="color: #333333; font-family: Source Sans Pro, Open Sans, Helvetica Neue, Helvetica, Arial, sans-serif;">COPYRIGHT:</span><br />
<span style="color: #333333; font-family: "Source Sans Pro", "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif;">Copyright © 2018 Treatment Scores, Inc. All Rights Reserved.</span>BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-62318899765521540092018-06-10T13:09:00.003-04:002018-06-10T13:12:36.777-04:00What is the Treatment Score for that?Whenever you are undergoing a medical treatment, you need to ask, "What is the Treatment Score for that?<br />
<br />
The Treatment Score = the net treatment benefit for the patient. The higher the Treatment Score the better the treatment effect for patients as summarized from the medical literature.<br />
<br />
Undertreatment and overtreatment occur because we don't know the Treatment Scores for anything. Runaway healthcare costs are happening because we don't know the Treatment Scores. If you undergo a treatment, does the medical literature suggest that patients will live only 2.6 weeks longer or 10 years longer? What is the cost/benefit for you? Knowledge is power.<br />
<br />
Does a new treatment have a Treatment Score of 95% in terms of curing a disease, but you don't even know about it?<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFJ9L4ya5czZLZg4qfJB7ETvjB4xnUIU2vkQYlSzj3Z2FMo2MgJMWoGJ9CkzbDS7VLZE26MA3Y2f3fvMvz-2GaY8TXP3j4x1D2uClDSZIdvjWqAemvXUVV32kgg3EU3NZ3Cednp7P2aV4/s1600/border+300x300x96+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFJ9L4ya5czZLZg4qfJB7ETvjB4xnUIU2vkQYlSzj3Z2FMo2MgJMWoGJ9CkzbDS7VLZE26MA3Y2f3fvMvz-2GaY8TXP3j4x1D2uClDSZIdvjWqAemvXUVV32kgg3EU3NZ3Cednp7P2aV4/s1600/border+300x300x96+1.png" /></a></div>
<br />
Importantly, the Treatment Score = the net treatment benefit for the patient (with the patients' values and preferences included). Treatment Scores allow for value-based healthcare to actually happen.<br />
<br />
Got cancer? What is the Treatment Score for your suggested chemotherapy?<br />
<br />
Got Alzheimer's disease? What are the Treatment Scores for Aricept, Namenda, Depakote, Zoloft, and Mobic? These are all medications that someone with Alzheimer's might be given.<br />
<br />
Got insomnia? There are 130 treatments. What are the Treatment Scores for each and every one of those Treatments?<br />
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Have you ever wondered why you are not given this simple number, "the net treatment benefit," for any medical treatment (especially when it is life and death important)? Why is it that we can figure out "gross income" and "net income" every year, but we cannot figure out "gross treatment benefit" and "net treatment benefit" for patients? Answer: It's because the math is difficult.<br />
<br />
Treatment Scores solve these problems:<br />
<br />
<ol>
<li>Health illiteracy, because Treatment Scores are simple to understand.</li>
<li>Runaway healthcare costs. We cut healthcare costs by creating treatment transparency for all medical treatments. Treatment Scores are the starting point for evidence-based medicine with shared decision-making.</li>
<li>Lack of time. We save doctors, patients, nurses, insurers, and governments time because we digest the medical literature down to one number.</li>
</ol>
<br />
DISCLAIMER: Always see your own licensed medical physician for diagnosis and treatment. Treatment Scores are for informational purposes only.BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-11108056402527155892018-05-06T08:36:00.000-04:002018-05-31T12:23:54.286-04:00Treatment Scores fix Problems<div class="gmail_default" style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 16px;">
Treatment Scores are for the web, mobile web, and digital health. Treatment Scores solve three of healthcare's biggest problems: patient involvement, patient engagement, and shared decision-making. Treatment Scores save time, money, improve quality, and have the potential to solve health illiteracy. Treatment Scores make evidence-based medicine understandable.</div>
<div class="gmail_default" style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 16px;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkPMBI_S2NzAqRCGdApu_eXE5q4MLpWh4Jwo6MMAc-wV3pHaE7w099uOx9od0j-MPJouxdgIXta83lAiXkXi8YP1U94OV1mFZCCZFZfijQ77zgqgZ0jLUuZczbM-4xz2R4sxPhLjCqMUQ/s1600/border+300x300x96+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkPMBI_S2NzAqRCGdApu_eXE5q4MLpWh4Jwo6MMAc-wV3pHaE7w099uOx9od0j-MPJouxdgIXta83lAiXkXi8YP1U94OV1mFZCCZFZfijQ77zgqgZ0jLUuZczbM-4xz2R4sxPhLjCqMUQ/s1600/border+300x300x96+1.png" /></a></div>
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Many of the buzzwords currently going around can only truly happen with Treatment Scores:</div>
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<ul>
<li><b>personalized medicine</b></li>
<li><b>treatment transparency</b></li>
<li><b>patient empowerment</b></li>
<li><b>patient engagement</b></li>
<li><b>quality-based care</b></li>
<li><b>value-based care</b></li>
<li><b>precision medicine</b></li>
<li><b>informed consent</b></li>
</ul>
<span style="color: #222222; font-family: arial, sans-serif; font-size: 16px;"><br /></span>
<span style="color: #222222; font-family: arial, sans-serif; font-size: 16px;">Cost benefit analyses cannot be done without Treatment Scores.</span><br />
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Think of it in obvious terms. Every year you calculate your net income:</div>
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<div class="gmail_default" style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 16px;">
<i>Net income = Gross Income - expenses.</i></div>
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Yet, in the whole history of medicine, we have never routinely calculated the "net treatment benefit for the patient," which we call the Treatment Score.</div>
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<i>Treatment Score = gross treatment benefit + side benefits - side effects.</i></div>
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It's a lot of math; often 10,000 variables. Treatment Scores may be a technology a few minutes ahead of its time, because few people understand medical statistics. However, software is solving that problem, because it puts a graphical user interface over the math.</div>
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Treatment Scores are likely to help you personally someday. Treatment Sores have the potential to save lives and keep people healthy. </div>
BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com1tag:blogger.com,1999:blog-3721609999509837563.post-38439394971354434982018-03-22T18:32:00.001-04:002018-03-22T22:17:25.371-04:00WEGO Health publishes article about Treatment Scores<div class="separator" style="clear: both; text-align: center;">
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<h1 class="entry-title" style="background-color: white; box-sizing: border-box; color: #3a3150; font-family: "Proxima Nova"; font-size: 32px; line-height: 1.3; margin: 0.25em 0px 0.45em;">
Treatment Scores: The Future of Medicine</h1>
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<span class="byline" style="box-sizing: border-box; padding-right: 0.5em;"><span class="author vcard" style="box-sizing: border-box;"><a class="url fn n" href="http://wegohealth.staging.wpengine.com/author/bradley-hennenfent/" style="background-color: transparent; box-sizing: border-box; color: #6748b6; text-decoration-line: none; touch-action: manipulation;">Stephen Fitzmeyer, M.D & Bradley Hennenfent, M.D.</a></span></span> </div>
We are pleased that WEGO Health published an article about Treatment Scores at the link shown below:<br />
<br />
<a href="https://www.wegohealth.com/2018/03/22/treatment-scores-the-future-of-medicine/">https://www.wegohealth.com/2018/03/22/treatment-scores-the-future-of-medicine/</a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgl140HH2Fs1yL4BvqnTainm3t7Y7vHHC_GGjZIhldthtpIiX5P7Y88dgCuUv2yI1O3w68YatQdqDjBgjLLg4jJNuxv_VY3vWTy4ggrIqeOoZfpbbIjKtRYDHZrZfrShk_QW3VzDI5Lk/s1600/border+200x200x72+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="200" data-original-width="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgl140HH2Fs1yL4BvqnTainm3t7Y7vHHC_GGjZIhldthtpIiX5P7Y88dgCuUv2yI1O3w68YatQdqDjBgjLLg4jJNuxv_VY3vWTy4ggrIqeOoZfpbbIjKtRYDHZrZfrShk_QW3VzDI5Lk/s1600/border+200x200x72+1.png" /></a></div>
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From the WEGO Health website:<br />
<span style="background-color: white; color: #3a3150; font-family: "proxima nova"; font-size: 24px;"><br /></span>
<span style="background-color: white; color: #3a3150; font-family: "proxima nova"; font-size: 24px;"><b>Who is WEGO Health?</b></span><br />
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WEGO Health is a mission-driven company connecting healthcare with the experience, skills and insights of Patient Leaders.</div>
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We are the world’s largest network of over 100k Patient Leaders, working across virtually all health conditions and topics. Our network collaborates with pharmaceutical and life sciences companies, agencies, consultancies, startups and all types of organizations across healthcare.</div>
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WEGO Health offers enterprise and on-demand solutions that allow organizations to leverage the patient experience and expertise in the design, development and promotion of their products and services.</div>
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<span style="color: #36373c; font-family: "raleway" , sans-serif;"><span style="font-size: 16px;"><a href="http://wegohealth.staging.wpengine.com/company-info/about/">http://wegohealth.staging.wpengine.com/company-info/about/</a></span></span></div>
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com1tag:blogger.com,1999:blog-3721609999509837563.post-10100343277331915022018-02-19T10:11:00.001-05:002018-02-19T10:11:44.928-05:00Treatment Scores: Social Media Update: Lies Damn Lies and Medical StatisticsOur common enemy is disease. Yet, there are three kinds of lies in healthcare: lies, damn lies, and medical statistics.* Partly because of this, and partly because of the difficult mathematics, there is an 88% health illiteracy rate (Health.gov) among patients.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaAXTl-yA8w_iQPgk5fwlVKtbyG_t8LHE2y27xffCPisglPdeHoqZdOXh_6OK3P22CgodOPw4T-fOKX71S-e7o8CHv9zQGCoowNfKyo4J8Xwi7MnJhaaLmKtrGFw6xgpugtHWAY6Y8u8s/s1600/264x264x72+HELP+BORDER+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="264" data-original-width="264" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaAXTl-yA8w_iQPgk5fwlVKtbyG_t8LHE2y27xffCPisglPdeHoqZdOXh_6OK3P22CgodOPw4T-fOKX71S-e7o8CHv9zQGCoowNfKyo4J8Xwi7MnJhaaLmKtrGFw6xgpugtHWAY6Y8u8s/s200/264x264x72+HELP+BORDER+1.png" width="200" /></a></div>
Just as bad, 60 – 80% of physicians don’t understand evidence-based medicine depending upon which outcome measure you use. (“Do clinicians understand the size of treatment effects? A randomized survey across eight countries,” by Bradley C. Johnston, PhD, et al.)<br />
<br />
You should follow Treatment Scores on social media. The following trendy buzzwords can actually come true using Treatment Scores:<br />
<br />
<br />
<ol>
<li>Patient-centered care</li>
<li>Patient engagement</li>
<li>Patient empowerment</li>
<li>Shared decision-making</li>
<li>Evidence-based medicine</li>
<li>Treatment transparency</li>
<li>Personalized medicine</li>
<li>Patient safety</li>
<li>Value-based care determined by patients, doctors, and nurses</li>
<li>Quality-based care determined by patients, doctors, and nurses</li>
<li>Precision medicine</li>
<li>Informed consent</li>
</ol>
<br />
We can also solve health illiteracy with Treatment Scores.<br />
<br />
Facebook<br />
226,000 likes<br />
<a href="https://www.facebook.com/TreatmentScores">https://www.facebook.com/TreatmentScores</a><br />
<br />
Twitter<br />
10,800 followers<br />
<a href="https://twitter.com/TreatmentScores">https://twitter.com/TreatmentScores</a><br />
<br />
Treatment Scores Blog<br />
97,244 pageviews<br />
<a href="http://treatmentscoresblog.com/">http://TreatmentScoresBlog.com</a><br />
<br />
AngelList.co<br />
91 connections<br />
<a href="https://angel.co/treatment-scores">https://angel.co/treatment-scores</a><br />
<br />
AngelList.co<br />
1,271 Connections<br />
<a href="https://angel.co/Bradley-Hennenfent">https://angel.co/Bradley-Hennenfent</a><br />
<br />
Twitter<br />
23,900 followers<br />
<a href="https://twitter.com/BradMD">https://twitter.com/BradMD</a><br />
<br />
LinkedIn<br />
6,131 connections<br />
<a href="https://www.linkedin.com/in/BradMD">https://www.linkedin.com/in/BradMD</a><br />
<br />
Stephen Fitzmeyer, MD<br />
Twitter<br />
22 followers<br />
<a href="https://twitter.com/DrFitzmeyer">https://twitter.com/DrFitzmeyer</a><br />
<br />
Stephen Fitzmeyer, MD<br />
LinkedIn<br />
509 connections<br />
<a href="https://www.linkedin.com/in/sfitzmeyer/">https://www.linkedin.com/in/sfitzmeyer/</a><br />
<br />
Jeffrey A. Schwartz, MD<br />
LinkedIn<br />
333 connections<br />
<a href="https://www.linkedin.com/in/jeffrey-a-schwartz-md-facep-0a487314/">https://www.linkedin.com/in/jeffrey-a-schwartz-md-facep-0a487314/</a><br />
<br />
Stephen Hennenfent, MD<br />
LinkedIn<br />
37 connections<br />
<a href="https://www.linkedin.com/in/stephen-hennenfent-6a790079/">https://www.linkedin.com/in/stephen-hennenfent-6a790079/</a><br />
<br />
AngelMD.co<br />
8 followers<br />
<a href="https://www.angelmd.co/startups/treatmentscoresinc">https://www.angelmd.co/startups/treatmentscoresinc</a><br />
<br />
<b>REFERENCE</b><br />
*There are three kinds of lies: lies, damn lies, and statistics. - is sometimes credited to Benjamin Disraeli or Mark Twain. We put a slant on the sentence by using medical statistics instead of statistics.<br />
<br />
<b>DISCLAIMERS</b><br />
You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for informational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.<br />
<br />
COPYRIGHT:<br />
Copyright © 2018 Treatment Scores, Inc. All Rights Reserved.<br />
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-18712814838697357332018-02-05T10:27:00.000-05:002018-02-07T10:06:58.046-05:00Solving Health Illiteracy: Pancreatic Cancer, Steve Jobs, & Smart PhonesI’m scared to death of pancreatic cancer. Celebrities like Patrick Swayze (Dirty Dancing) and astronaut Sally Ride have died from pancreatic cancer. Overall, only 1% of patients live for 10 years after being diagnosed with pancreatic cancer. Many friends of friends have died from pancreatic cancer. I hate pancreatic cancer. It's emotionally devastating.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8sIxZ122OuOGoaqtLn98PSAkE0xu1TS1OuylJ48gzMVd7qtvr6mA8V_imuPJ3hdFmN15uJ2vmSkHfZbUYh2VjR6iTXRWfQIFNs7HImhrG5M-uQ9rHAxYm6pyy6mQDuGJPc0ZdvSDeNt4/s1600/200x200x72+2+BORDER.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="200" data-original-width="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8sIxZ122OuOGoaqtLn98PSAkE0xu1TS1OuylJ48gzMVd7qtvr6mA8V_imuPJ3hdFmN15uJ2vmSkHfZbUYh2VjR6iTXRWfQIFNs7HImhrG5M-uQ9rHAxYm6pyy6mQDuGJPc0ZdvSDeNt4/s1600/200x200x72+2+BORDER.png" /></a></div>
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<b>TREATMENTS</b><br />
When you get sick you need a list of treatments, and you need to know the “net treatment benefit” for each treatment (as summarized from existing medical studies). You would think it would be easy to get the “net treatment benefit” for a medical treatment, but in fact it’s nearly impossible, because the statistics are so disorganized. Also, many medical studies do not have a “control group” that compares treatment versus no treatment, or treatment versus placebo, or treatment vs. sham surgery.<br />
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There are two main kinds of pancreatic cancer, “neuroendocrine” and “adenocarcinoma.” Neuroendocrine is less common and less lethal.<br />
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There is hope. The American Cancer Society reports that even patients with stage 4, neuroendocrine, pancreatic cancer, who did not have surgery, had a 5-year survival rate of 16%. Stage 1, 2, and 3 are considered less lethal.<br />
<a href="https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html">https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html</a><br />
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<b>STEVE JOBS</b><br />
I decided to focus this essay on the most curable type of pancreatic cancer, stage 1, neuroendocrine, pancreatic cancer. Stage 1 is a small cancer localized to the pancreas, and in many studies the 5-year survival is over 50% for these particular patients.<br />
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Allegedly, Steve Jobs had “stage 1 neuroendocrine pancreatic cancer.” My apologies to Steve Job’s family and friends. May he rest in peace. I have no inside information about his case, but am using what has been reported in the media, which may or may not be accurate, for learning purposes.<br />
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<b>TREATMENTS AND TREATMENTS SCORES</b><br />
Let’s say that I am diagnosed with <b>pancreatic cancer, neuroendocrine, stage 1</b>. Obviously, I would want to know how much each treatment would increase my 5-year survival.<br />
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I call “the net treatment benefit as summarized from the medical literature” the <b>Treatment Score</b>. I need a list of treatments and Treatment Scores. (See disclaimers below). Treatment Scores would fit easily on your smart phone.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4d7ykL0jDNjSkuVtUIQNTi1hhhWfbylNFEUjX-WrtthztqKkFWnYxOllvQ4D7iHaUh52zEJ1egLXoFsMZ9BGVFYcO4NjLbi_qN9oe76yl8rTb2Z8MCQxyO5aay1wXTPK-L995lfP7ZY8/s1600/final+500x957x96+9+LABELS.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="957" data-original-width="500" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4d7ykL0jDNjSkuVtUIQNTi1hhhWfbylNFEUjX-WrtthztqKkFWnYxOllvQ4D7iHaUh52zEJ1egLXoFsMZ9BGVFYcO4NjLbi_qN9oe76yl8rTb2Z8MCQxyO5aay1wXTPK-L995lfP7ZY8/s640/final+500x957x96+9+LABELS.png" width="332" /></a></div>
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In the graphic, I gave surgery a <b>Treatment Score of 10%</b>. I gave the chemotherapy, Gemzar® (gemcitabine), a <b>Treatment Scores of 0%</b>. And, I also scored many other treatments, which I will discuss.<br />
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<b>THE NET TREATMENT BENEFIT</b><br />
To figure out your income, you need the formula:<br />
<br />
<i>Net income = gross income – expenses. </i><br />
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To figure out your medical treatments you need the formula:<br />
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<i>Gross Benefit + side benefits – side effects = Net Benefit. </i><br />
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Follow the graphic in a clockwise direction to get to go from the <b>Gross Benefit</b> to the <b>Net Benefit</b>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn0MQgDuwl8fOs7_7gnULcCIQbEx5E48uJJrYyS-bMCDJwkLCKL1CRmVpipiWAEZJIT3z2YKswpvEABoMyfdjyityYB9T-1v5squjISu6QYmMaEqkrpI5nHkX_FkunXhdVJxNWbcixP7Y/s1600/300x300x72+border+2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn0MQgDuwl8fOs7_7gnULcCIQbEx5E48uJJrYyS-bMCDJwkLCKL1CRmVpipiWAEZJIT3z2YKswpvEABoMyfdjyityYB9T-1v5squjISu6QYmMaEqkrpI5nHkX_FkunXhdVJxNWbcixP7Y/s1600/300x300x72+border+2.png" /></a></div>
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Simple right? No! Figuring out the “net treatment benefit” is anything but simple, it’s complicated. It’s damn near impossible, but it shouldn’t be. Your life is at stake and your health is at risk. What could be more important?<br />
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Part of what is so difficult is that the side effects are almost all on different scales. For example, if there is a 20% rate of “delayed gastric emptying” (stomach paralysis) from surgery, you have to convert that side effect onto the 5-year survival scale before subtracting it. That means you must “weight” the side effect and convert it. You must “weight” all the side effects and convert all of them. It’s like converting your expenses in Euros, and your expenses in Pesos, etc. into US dollars, and then subtracting them to figure out your total income in US dollars.<br />
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<b>STEVE JOBS</b><br />
Much of what we might know about Steve Jobs, the former CEO of Apple, and pancreatic cancer comes from the Walter Isaacson authorized biography, <i>Steve Jobs</i>, published in 2012. Many great articles were inspired by Steve Job’s death (and his biography) which are worth reading.<br />
<br />
<b>Steve Jobs was diagnosed with pancreatic cancer in October, 2003.</b><br />
<a href="http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510">http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510</a><br />
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<b>Steve Jobs had surgery July, 2004.</b><br />
<a href="http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510">http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510</a><br />
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<b>Steve Jobs had a liver transplant in 2009.</b><br />
<a href="http://healthland.time.com/2011/10/05/the-pancreatic-cancer-that-killed-steve-jobs/">http://healthland.time.com/2011/10/05/the-pancreatic-cancer-that-killed-steve-jobs/</a><br />
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<b>Steve Jobs died in 2011.</b><br />
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Steve Jobs reportedly tried to treat his cancer with a “special diet.”<br />
<a href="http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510">http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510</a><br />
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According to the New York Times it was a vegan diet.<br />
<a href="http://www.nytimes.com/2011/11/01/health/hindsight-is-kind-to-steve-jobss-decision-to-delay-surgery.html">http://www.nytimes.com/2011/11/01/health/hindsight-is-kind-to-steve-jobss-decision-to-delay-surgery.html</a><br />
<br />
Steve Jobs may have tried acupuncture, hydrotherapy, and various other treatments.<br />
<a href="http://www.sciencebasedmedicine.org/one-more-thing/">http://www.sciencebasedmedicine.org/one-more-thing/</a><br />
<br />
After his death, one physician, Dr. Robert Wascher, MD, suggested that Jobs should have tried turmeric (a spice) as a treatment.<br />
<a href="https://www.naturalnews.com/033992_turmeric_pancreatic_cancer.html">https://www.naturalnews.com/033992_turmeric_pancreatic_cancer.html</a><br />
<br />
<b>SURGERY – “THE WHIPPLE”</b><br />
The surgery for pancreatic cancer is often called the “Whipple Procedure” after Dr. Allen Whipple who invented it at Columbia Presbyterian Hospital in 1935. The medical name is “pancreaticoduodenectomy.”<br />
<br />
Pancreatic surgery is one of the most serious and major surgeries patients can undergo. There are many potential complications. There is an excellent video, “The Whipple Procedure,” from Johns Hopkins medicine which will help you understand this massive operation:<br />
<a href="https://youtu.be/4Zxvm3MSb8k">https://youtu.be/4Zxvm3MSb8k</a><br />
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<b>SURGERY - BRAGGING</b><br />
The Whipple procedure is so dangerous that in the past 25% of patients used to die from the operation alone. Surgeons actually “brag” (as they should) in the medical literature about doing a series of surgeries without killing any patients.<br />
<br />
German surgeons operated on 118 patients in row without any deaths.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/2322039">https://www.ncbi.nlm.nih.gov/pubmed/2322039</a><br />
<br />
Japanese physicians (Hiroshima) did 150 surgeries in row without any deaths.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/18050288">https://www.ncbi.nlm.nih.gov/pubmed/18050288</a><br />
<br />
Australian physicians did 178 in a row without any deaths.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/21813392">https://www.ncbi.nlm.nih.gov/pubmed/21813392</a><br />
<br />
Brazilian physicians did 214 in a row without any deaths.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/27266408">https://www.ncbi.nlm.nih.gov/pubmed/27266408</a><br />
<br />
Japanese physicians (Tokyo) did 368 in a row without any deaths.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/28103418">https://www.ncbi.nlm.nih.gov/pubmed/28103418</a><br />
<br />
<b>TREATMENT – SURGERY – TREATMENT SCORE</b><br />
As mentioned earlier, I gave surgery a Treatment Score of 10% as an increase in 5-year survival. It was incredibly hard to come up with a reasonable number, because the studies typically being cited are case-series studies without any controls. Stage 1, neuroendocrine, pancreatic cancer is the least lethal type, and many patients, even most patients, may live for 5 years without surgery. The range for the Treatment Score of 10% is large, because there are no controls and not enough patients (which in the future we will show with animations). Here is the background data that has to be converted and subtracted. It's <i>main outcome - side effects = Treatment Score</i>. You will be able to see all this, and more, on your smart phone.<br />
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It’s easy to exaggerate the benefit of medical treatments. In fact, it’s easy to lie with medical statistics, because few people understand them, and they are often flawed or biased. One physician, Dr. Birgir Gudjonsson, wrote a great paper about the situation: “Survival statistics gone awry: pancreatic cancer, a case in point.”<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/12172365">https://www.ncbi.nlm.nih.gov/pubmed/12172365</a><br />
<br />
<b>TREATMENT – SURGERY CONTROLS</b><span style="white-space: pre;"> </span><br />
When I started this project, I expected that surgery vs. no surgery would be a slam dunk. I thought surgery for stage 1, neuroendocrine, pancreatic cancer was wildly successful, nearly 100% successful even, but instead it’s murky. It’s hard to find any controls.<br />
<br />
How do we control for surgery vs. no surgery? One idea is to look at 5-year survival and 10-year survival. If surgery is curing everyone at 5 years, there will be no deaths at 10 years, right? One prestigious source has 5-year survival at 61% and 10-year survival at 52%. So, 9% more patients died over the next 5 years. There is the issue of "competing mortality" however.<br />
<a href="https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html">https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html</a><br />
<br />
I tried to zero in on any controlled study I could find. I found an older one, an imperfect study, that compared surgery to medical treatment in 124 patients total, and reported that only 3% who underwent surgery developed liver metastases while 23% who had medical therapy developed liver metastases. Presumably, preventing liver metastases also prevents death from cancer. Does this mean that surgery cures about 20% of patients?<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/7916560">https://www.ncbi.nlm.nih.gov/pubmed/7916560</a><br />
<br />
What needs to be done? There is a group of 211 patients who did not have surgery, who were stage 1, neuroendocrine, pancreatic cancer. If someone could go back and review their 5-year overall survival we could finally have a “historical” control group. This control group, or any other control group versus surgery, might turn everything we think we know about neuroendocrine pancreatic cancer upside down.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/17903729">https://www.ncbi.nlm.nih.gov/pubmed/17903729</a><br />
<br />
Evidence-based medicine is done to remove biases and uncertainty about medical statistics. Removing biases, removing fiction from fact is why “blinded” randomized controlled trials are done. But, they are hard to do, and we often look to other controlled studies for help. We definitely need help with understanding the true treatment effects when it comes to pancreatic cancer.<br />
<br />
<b>TREATMENT - SURGERY - LEAD-TIME BIAS</b><br />
All of the benefit from surgery in the medical literature for stage 1 could be due to lead time bias. If you diagnose the disease earlier, in younger people than before, the 5-year survival will go up whether the treatment makes any difference or not. We see this false increase in survival all the time in cancer studies.<br />
<br />
<b>TREATMENT – SURGERY – OVERALL SURVIVAL</b><br />
Exactly how you calculate survival makes a difference too. Are you using simple survival? 100% alive now and 50% alive in 5 years? What about people who die from heart attacks, strokes, accidents and so forth during those 5 years? People who die from things other than their cancer did not benefit from their cancer treatment, so the treatment benefit would go down. Those patients should not count as being cured of cancer, because the patient did not actually benefit. That’s why I prefer the “overall survival” statistic when I can get it. Overall survival takes these things into account, because it adjusts for “reality.”<br />
<br />
<b>TREATMENT - ACUPUNCTURE</b><br />
I gave acupuncture a Treatment Score of NSD (No Specific Data). There are studies in human beings, but there are no studies specifically suggesting acupuncture increases 5-year survival for stage 1, neuroendocrine, pancreatic cancer. In our software, if you click on the Treatment Score, you can see the underlying references. You can verify the references, and you can see that none of them are directly applicable.<br />
<br />
<b>TREATMENT – FRUIT DIET</b><br />
I gave eating a fruit diet a Treatment Score of NSD (No Specific Data), because although there are human studies that suggest a fruit diet may act against cancers, there are no specific human studies suggesting a fruit diet increases survival for stage 1, neuroendocrine, pancreatic cancer.<br />
<br />
<b>TREATMENT – HYDROTHERAPY</b><br />
Hydrotherapy is “water therapy.” It is a form of alternative medicine, where water is used to treat pain or disease. I gave hydrotherapy a Treatment Score of NSD (No Specific Data), because I did not find studies specifically about hydrotherapy increasing survival for stage 1, neuroendocrine, pancreatic cancer.<br />
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<b>TREATMENT - TANGENT</b><br />
As an aside, I do not “hate” alternative medicine. Far from it! I want all medical treatments to work, and to be proven to work, because that would be best for patients. Some alternative medicine treatments, herbs, therapies, and so forth do have good, or even great, medical studies supporting their use. I just want everyone to know what the existing medical studies say for every treatment, and for that information to be presented in an understandable fashion. I also want all alternative medicines that seem to work in the laboratory, or in mice studies, to go on to be tested in human beings in a safe and ethical fashion. I also understand why someone facing death would be willing to try an herb or supplement, when there are no good specific medical studies in humans, especially if that herb or supplement is known to be harmless, and inexpensive. Let’s make WHAT WE DO KNOW perfectly clear, and let’s always present the data in an easy to understand way.<br />
<br />
<b>TREATMENT – JUICE FASTING</b><br />
I gave juice fasting a Treatment Score of NSD (No Specific Data), because although there are human studies that suggest benefits, there are no studies that document a specific benefit for increasing survival in stage 1, neuroendocrine, pancreatic cancer.<br />
<br />
<b>TREATMENT – PSYCHIC THERAPY</b><br />
I gave psychic therapy a Treatment Score of NSD (No Specific Data). There were definitely not any studies showing a survival benefit for stage 1, neuroendocrine, pancreatic cancer. I thought coming up with a Treatment Score for psychic therapy would be fun. Instead, it was a bit of nightmare. There are studies and surveys using human beings, but everything I could find was very off-topic and tangential.<br />
<br />
<b>TREATMENT – GEMZAR® (GEMCITABINE)</b><br />
I gave the chemotherapy, Gemzar® (gemcitabine), a Treatment Score of 0% for 5-year survival. It’s sad, because it is one of the few chemotherapy options. However, Gemzar® may have a positive Treatment Score if you use a shorter time period such as 1-year survival, or 1-month survival. That's a future essay.<br />
<br />
<b>TREATMENT – PINEAPPLE</b><br />
A businessman sent me an incredibly well-written, convincing, article about how pineapple cures cancer. When I dug into it, it was all based on a single laboratory study. Entire bodies of literature show over and over again why lab studies and animal studies do not translate well to human beings. I gave pineapple a Treatment Sore of NHD (No Human Data), because I could not find any human studies related to stage1 , neuroendocrine, pancreatic cancer that were relevant enough to use. There are some intriguing tangential studies with pineapple, or pineapple ingredients (bromelain), that have been done in the laboratory, so I would like to see studies done with human beings.<br />
<br />
<b>TREATMENT – VEGAN DIET</b><br />
I gave the vegan diet a Treatment Score of NSD (No Specific Data), because I could not find any convincing human studies that once you had stage 1, neuroendocrine, pancreatic cancer a vegan diet might increase your survival. Fortunately, there is a study in the works to see if a vegan diet might increase survival in cancer:<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/27473726">https://www.ncbi.nlm.nih.gov/pubmed/27473726</a><br />
<br />
There are studies that suggest a vegan diet might help prevent cancer. But I could not find any specific studies showing a vegan diet would help cure you once you already had this kind of pancreatic cancer.<br />
<br />
<b>TREATMENT – TURMERIC</b><br />
I gave turmeric a Treatment Score of NHD (No Human Data). There are some very interesting laboratory studies with turmeric, so I would love to see some human studies get done. Turmeric has an ingredient, curcumin, that is featured in many laboratory studies as probably having anti-pancreatic cancer effects. Studies in human beings need to be done.<br />
<br />
<b>A BETTER WORLD</b><br />
Wouldn’t it be a better world if there was a graphical user interface (GUI) over evidence-based medicine? Then, you could get a list of treatments and Treatment Scores for whatever you are diagnosed with. Our Treatment Scores system would help solve undertreatment, overtreatment, and mistreatment. It would educate everyone.<br />
<br />
What would Steve Jobs have done if all of this information had been organized and ready for him on day 1 of his diagnosis? The unanswerable question is: Would he still be alive today? Remember, 9 months went by between his diagnosis and his surgery. Did the cancer metastasize (spread) and become incurable during those 9 months?<br />
<br />
Who could blame anyone for taking some time to think before undergoing a major surgery? The problem is that it literally takes months to read all the studies, find all the medical statistics, and understand them. With Treatment Scores you can do all that in 10 minutes.<br />
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It’s frustrating! The entire medical system should be geared toward figuring out the “net treatment benefit” for the patient, but sadly it is not. Let’s change this. What would really be helpful would be a credible group of PhDs, doctors, nurses, and patients, who put patients first. We need people who are not working for Academia, Government, or Industry (or who declare their bias when they are), who produce Treatment Scores that are done transparently. That way we would not have to spend countless hours trying to understand medical treatments, and we could begin to solve the 88% health illiteracy problem.<br />
<br />
<b>LIMITATIONS</b><br />
This essay is not claiming accuracy. It will be redone. It will be improved. Right now, it is for technique. It is about how we need to provide better treatment transparency to patients. The underlying data is highly uncertain (again, something that we will eventually show with animations). Most studies are case-series studies, which are considered low quality, and often are biased. Many assumptions have to be made. For example, I had to assume that surgery for stage 1, neuroendocrine, pancreatic cancer was somewhat similar to surgery for any stage or type of pancreatic cancer, but in theory surgery should be somewhat less risky when the disease is not as advanced.<br />
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<b>HELP</b><br />
The old way is not working. We have an 88% health illiteracy rate (Health.gov). We need experts working on Treatment Scores. If you want to HELP US help patients understand the “net treatment benefit” please email me at <a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
<b>Twitter: </b><br />
<a href="https://twitter.com/TreatmentScores">https://Twitter.com/TreatmentScores</a><br />
<br />
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<a href="https://facebook.com/TreatmentScores">https://Facebook.com/TreatmentScores</a><br />
<br />
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<a href="https://angel.co/treatment-scores">https://angel.co/treatment-scores</a><br />
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<b>DISCLAIMERS</b><br />
This essay is not medical advice. You must consult your own licensed physician for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for informational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We (everyone, and every entity, involved in any way) DO NOT claim to cure, treat, or prevent any illness or condition. We DO NOT provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our essay, website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.<br />
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<b>REFERENCES - BEGINNING</b><br />
Cancer Research UK, (source for 1% survival statistic).<br />
http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/common-cancers-compared#heading-Zero<br />
Accessed January 22, 2018.<br />
<br />
Pancreatic Cancer Survival Rates, by Stage. Last Revised: May 31, 2016.<br />
https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html<br />
Accessed January 26, 20018.<br />
<br />
Ranker.com (Source for celebrity deaths)<br />
https://www.ranker.com/list/famous-people-who-died-of-pancreatic-cancer/reference<br />
Accessed January 25, 2018.<br />
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Columbia Surgery: History of Medicine: Whipple's Improvised Breakthrough<br />
http://columbiasurgery.org/news/2015/11/12/history-medicine-whipples-improvised-breakthrough<br />
Accessed January 25, 2018.<br />
<b><br /></b>
<b>REFERENCES - LYING WITH STATISTICS</b><br />
Gudjonsson, Birgir. “Survival statistics gone awry: pancreatic cancer, a case in point.”<br />
J Clin Gastroenterol. 2002 Aug;35(2):180-4.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=12172365<br />
<br />
<b>REFERENCES - STEVE JOBS</b><br />
The Pancreatic Cancer That Killed Steve Jobs, by Alice Park. TIME Magazine.<br />
http://healthland.time.com/2011/10/05/the-pancreatic-cancer-that-killed-steve-jobs/<br />
Accessed January 25, 2018.<br />
<br />
The trouble with Steve Jobs, by Peter Elkind, FORTUNE, March 5, 2008.<br />
http://fortune.com/2008/03/05/the-trouble-with-steve-jobs/?postversion=2008030510<br />
Accessed January 25th, 2018.<br />
<br />
A Tumor Is No Clearer in Hindsight, by Denise Grady. Oct. 31, 2011.<br />
http://www.nytimes.com/2011/11/01/health/hindsight-is-kind-to-steve-jobss-decision-to-delay-surgery.html<br />
Accessed January 25th, 2018.<br />
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The early detection of cancer and improved survival: More complicated than most people think, by David Gorski, May 12, 2008.<br />
http://www.sciencebasedmedicine.org/one-more-thing/<br />
Accessed January 1, 2018.<br />
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Turmeric spice could have cured pancreatic cancer that killed Steve Jobs, suggests oncologist, by Jonathan Benson. October 27, 2011, Natural News.<br />
https://www.naturalnews.com/033992_turmeric_pancreatic_cancer.html<br />
Accessed January 25th, 2018.<br />
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<b>REFERENCES - TURMERIC</b><br />
Curcumin Induces Autophagy, Apoptosis, and Cell Cycle Arrest in Human Pancreatic Cancer Cells.<br />
https://www.ncbi.nlm.nih.gov/pubmed/29081818<br />
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Curcumin sensitizes pancreatic cancer cells to gemcitabine by attenuating PRC2 subunit EZH2, and the lncRNA PVT1 expression.<br />
https://www.ncbi.nlm.nih.gov/pubmed/29048549<br />
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Inhibition of Cell Survival by Curcumin Is Associated with Downregulation of Cell Division Cycle 20 (Cdc20) in Pancreatic Cancer Cells.<br />
https://www.ncbi.nlm.nih.gov/pubmed/28165402<br />
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331540/<br />
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Curcumin-Free Turmeric Exhibits Activity against Human HCT-116 Colon Tumor Xenograft: Comparison with Curcumin and Whole Turmeric.<br />
https://www.ncbi.nlm.nih.gov/pubmed/29311914<br />
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<b>REFERENCES – SURGERY WITHOUT DEATHS</b><br />
Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447-58. Department of Surgery, Klinikum Mannheim, Heidelberg University, West Germany.<br />
https://www.ncbi.nlm.nih.gov/pubmed/2322039<br />
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No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy. J Surg Oncol. 2008 Mar 1;97(3):205-9.<br />
Murakami Y1, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Nakagawa N, Ohge H, Sueda T. Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=18050288<br />
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One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach. Hepatobiliary Pancreat Dis Int. 2011 Aug;10(4):415-21. Samra JS1, Bachmann RA, Choi J, Gill A, Neale M, Puttaswamy V, Bell C, Norton I, Cho S, Blome S, Maher R, Gananadha S, Hugh TJ. Upper Gastrointestinal Surgical Unit, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=21813392<br />
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Laparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience. J Laparoendosc Adv Surg Tech A. 2016 Aug;26(8):630-4. Machado MA, Surjan RC, Basseres T, Silva IB, Makdissi FF.<br />
Department of Surgery, University of São Paulo , São Paulo, Brazil .<br />
Sírio Libanês Hospital, São Paulo, Brazil .<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=27115329<br />
<br />
Systematic use of isolated pancreatic anastomosis after pancreatoduodenectomy: Five years of experience with zero mortality. [214 patients] Eur J Surg Oncol. 2016 Oct;42(10):1584-90. doi: 10.1016/j.ejso.2016.05.023. Epub 2016 May 29.<br />
Machado MC, et al. Eur J Surg Oncol. 2016.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=27266408<br />
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Three hundred and sixty-eight consecutive pancreaticoduodenectomies with zero mortality. Oguro S, et al. J Hepatobiliary Pancreat Sci. 2017. Oguro S1, Yoshimoto J1, Imamura H, Ishizaki Y, Kawasaki S.<br />
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=28103418<br />
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Systematic use of isolated pancreatic anastomosis after pancreatoduodenectomy: Five years of experience with zero mortality. [214 patients] Eur J Surg Oncol. 2016 Oct;42(10):1584-90. doi: 10.1016/j.ejso.2016.05.023. Epub 2016 May 29.<br />
Machado MC, et al. Eur J Surg Oncol. 2016.<br />
https://www.ncbi.nlm.nih.gov/pubmed/?term=27266408<br />
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<b>REFERENCES – SURGERY URLS</b><br />
Here is a sample of surgery-related URLS:<br />
<br />
http://www.ncbi.nlm.nih.gov/pubmed/25885408<br />
https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html<br />
https://www.ncbi.nlm.nih.gov/pubmed/11088073<br />
https://www.ncbi.nlm.nih.gov/pubmed/12192322<br />
https://www.ncbi.nlm.nih.gov/pubmed/17903729<br />
https://www.ncbi.nlm.nih.gov/pubmed/25885408<br />
https://www.ncbi.nlm.nih.gov/pubmed/28341868<br />
https://www.ncbi.nlm.nih.gov/pubmed/28464575<br />
https://www.ncbi.nlm.nih.gov/pubmed/28895142<br />
https://www.ncbi.nlm.nih.gov/pubmed/29019886<br />
https://www.ncbi.nlm.nih.gov/pubmed/9339931<br />
<b><br /></b>
<b>REFERENCES – ACCUPUNCTURE</b><br />
Here is a sample of acupuncture related URLs.<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/24280575<br />
https://www.ncbi.nlm.nih.gov/pubmed/4808622<br />
https://www.ncbi.nlm.nih.gov/pubmed/26100066<br />
<br />
<b>REFERENCES – FRUIT DIET</b><br />
Here is a sample of fruit diet related URLs:<br />
<br />
http://www.ncbi.nlm.nih.gov/pubmed/17524168<br />
https://www.ncbi.nlm.nih.gov/pubmed/11678487<br />
https://www.ncbi.nlm.nih.gov/pubmed/15316829<br />
<br />
<b>REFERENCES – HYDROTHERAPY</b><br />
Here is a sample of URLs about hydrotherapy:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/13680321<br />
https://www.ncbi.nlm.nih.gov/pubmed/7992595<br />
https://www.ncbi.nlm.nih.gov/pubmed/7483377<br />
https://en.wikipedia.org/wiki/Hydrotherapy<br />
<b><br /></b>
<b>REFERENCES – JUICE FASTING</b><br />
Here is a sample of “Juice Fasting” URLs:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/16131283<br />
https://www.ncbi.nlm.nih.gov/pubmed/26176887<br />
https://www.ncbi.nlm.nih.gov/pubmed/21086570<br />
https://www.ncbi.nlm.nih.gov/pubmed/28216454<br />
<b><br /></b>
<b>REFERENCES – PSYCHIC THERAPY</b><br />
Sampling of URLs somewhat related to psychic therapy:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/21549256<br />
https://www.ncbi.nlm.nih.gov/pubmed/25685187<br />
https://www.ncbi.nlm.nih.gov/pubmed/11824916<br />
https://www.ncbi.nlm.nih.gov/pubmed/7931113<br />
https://www.theguardian.com/science/2009/may/12/psychic-claims-james-randi-paranormal<br />
https://www.ncbi.nlm.nih.gov/pubmed/25685187<br />
<br />
<b>REFERENCES - GEMZAR® (GEMCITABINE)</b><br />
Here are some URLs about Gemzar® and neuroendocrine cancer:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/24413782<br />
https://www.ncbi.nlm.nih.gov/pubmed/15329900<br />
https://www.ncbi.nlm.nih.gov/pubmed/20698050<br />
<br />
<b>REFERENCES – PINEAPPLE</b><br />
Here are some sample URLs about pineapple:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/23137025<br />
https://www.ncbi.nlm.nih.gov/pubmed/17893836<br />
https://www.ncbi.nlm.nih.gov/pubmed/10552641<br />
https://www.ncbi.nlm.nih.gov/pubmed/20713174<br />
https://www.ncbi.nlm.nih.gov/pubmed/12565169<br />
https://www.ncbi.nlm.nih.gov/pubmed/25820875<br />
https://www.ncbi.nlm.nih.gov/pubmed/24123777<br />
https://www.ncbi.nlm.nih.gov/pubmed/28157162<br />
https://www.ncbi.nlm.nih.gov/pubmed/22191568<br />
https://www.ncbi.nlm.nih.gov/pubmed/19700238<br />
<br />
<b>REFERENCES – TURMERIC</b><br />
Here are some sample references about turmeric:<br />
<br />
https://www.ncbi.nlm.nih.gov/pubmed/29311914<br />
https://www.ncbi.nlm.nih.gov/pubmed/28165402<br />
https://www.ncbi.nlm.nih.gov/pubmed/28259961<br />
https://www.ncbi.nlm.nih.gov/pubmed/28535906<br />
https://www.ncbi.nlm.nih.gov/pubmed/29081818<br />
https://www.ncbi.nlm.nih.gov/pubmed/29048549<br />
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<b>REFERENCES – URLS GENERAL</b><br />
https://www.ncbi.nlm.nih.gov/pubmed/28529726<br />
https://www.ncbi.nlm.nih.gov/pubmed/7916560<br />
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234386/<br />
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982911/<br />
https://www.ncbi.nlm.nih.gov/pubmed/27473726<br />
https://www.ncbi.nlm.nih.gov/pubmed/27101764<br />
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844163/<br />
https://www.ncbi.nlm.nih.gov/pubmed/26657045<br />
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<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-55601256677557197252018-01-18T09:57:00.000-05:002018-02-26T12:25:43.684-05:00The Net Treatment Benefit of the Mumps Measles & Rubella (MMR) Vaccine<div class="separator" style="clear: both; text-align: center;">
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When figuring out the benefits of the mumps, measles, & rubella vaccine, you need to use evidence-based medicine, medical ethics, and shared decision-making. The official name of the vaccine in use in the United States is M-M-R® II, which I will abbreviate as MMR II. Interestingly, you can use the exact same data to be pro-vaccine or anti-vaccine (for this particular vaccine). It depends on the assumptions you make, and the ranges of the data points. Surprisingly, you have to make assumptions, because there are no adequate randomized controlled studies (RCTs).<br />
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I’m a 15-month-old fictional toddler named Olivia. I’m telling this story because I’m the patient (you need to suspend your disbelief and assume a 15-month old can do all of this). Evidence-based medicine and medical ethics state that:<br />
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1.<span style="white-space: pre;"> </span>The patient comes first<br />
2.<span style="white-space: pre;"> </span>Patient-Important Outcomes should be used<br />
3.<span style="white-space: pre;"> </span>Patient-Centered Outcomes should be used<br />
4.<span style="white-space: pre;"> </span>Patient safety is paramount<br />
5.<span style="white-space: pre;"> </span>The patient’s values and preferences must be taken into account<br />
6.<span style="white-space: pre;"> </span>The patient deserves complete transparency.<br />
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<b>TREATMENT SCORES</b><br />
I, (15-month old Olivia) try to make medical treatments understandable. Usually, you give me a diagnosis and I come up with a list of treatments for that diagnosis with Treatment Scores.<br />
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The Treatment Score is defined as the:<br />
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“Net treatment benefit for the patient as summarized from the existing medical literature. It is determined by shared decision-making between you and your physician.”<br />
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One can see why it’s simpler to call it the “Treatment Score,” or the “net treatment benefit.” The Treatment Score is a way to summarize the “net treatment benefit” for the patient down to one number. I (baby Olivia) got tired of the fact that 88% of the population is health illiterate (Health.gov). For example, people do not understand that a chemotherapy can have a Treatment Score of zero, because that chemotherapy does not increase survival, which happens far more often than you would think.<br />
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People also do not understand than an “alternative medicine” can have a Treatment Score of “no data,” because there are no clinical studies of human beings undergoing that treatment. Similarly, people often disregard all “alternative medical treatments” as being bogus, when in fact, sometimes alternative medicines do have good studies to support them. We need a solution to all the confusion. We need Treatment Scores.<br />
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<b>THE DIAGNOSIS</b><br />
The diagnosis is “mumps, measles, and rubella prevention,” but we need to be more specific by making the diagnosis “mumps, measles, and rubella prevention in the United States.” Location turns out to be very important when it comes to risks and benefits.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgHt4mTVxKXL2j5woJQPWPj9XZXG8zffNi8iEjyuGxZxdQSujgO_hLee7e8vXMpXf6U_5yfcQJdAv-j_jeDsn7oez6iv-wkBKNg9QGyB0MO02iX0DlyT0FK-tx25Rl0dyX8o1MocwCmGs/s1600/diagnosis+rectangle+SMALLEST.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="125" data-original-width="402" height="99" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgHt4mTVxKXL2j5woJQPWPj9XZXG8zffNi8iEjyuGxZxdQSujgO_hLee7e8vXMpXf6U_5yfcQJdAv-j_jeDsn7oez6iv-wkBKNg9QGyB0MO02iX0DlyT0FK-tx25Rl0dyX8o1MocwCmGs/s320/diagnosis+rectangle+SMALLEST.png" width="320" /></a></div>
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<b>TREATMENT</b><br />
The treatment list turns out to be very short. Essentially, the only treatment available to prevent mumps, measles, & rubella (all three at once) is the MMR II vaccine. Having basically only one treatment is unlike other diagnoses such as “migraine headache,” which has 57 treatments, or “insomnia,” for which there are 130 treatments. I am currently unaware of any other treatment that allegedly prevents all three childhood diseases simultaneously, with the possible exception of “improving overall health.”<br />
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<b>OUTCOME MEASURE</b><br />
What is the most important outcome measure for me, a 15-month old toddler? This is where it gets interesting. There are a dizzying number of different outcome measures used in the medical literature. I (Olivia, think of me as an animated cartoon talking to you) am worried about two things:<br />
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1.<span style="white-space: pre;"> </span>Will the MMR II vaccine prevent me from dying?<br />
2.<span style="white-space: pre;"> </span>Will the MMR II vaccine prevent from me from suffering permanent disability from mumps, measles, or rubella?<br />
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Here is a treatment list:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirs4yko57EDkf25cPf59POloMPv6NtNQErg8_LPTIONGZEuonZnHZYL2SnTegkfcKuMQ6IJoPKnOPF_q92V9yuS4Sy1prxJBizbrW0OtxNiMoZwrGYgjawi1p28asg4FzsnG3GgOw8GQI/s1600/160x189x72+border.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="189" data-original-width="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirs4yko57EDkf25cPf59POloMPv6NtNQErg8_LPTIONGZEuonZnHZYL2SnTegkfcKuMQ6IJoPKnOPF_q92V9yuS4Sy1prxJBizbrW0OtxNiMoZwrGYgjawi1p28asg4FzsnG3GgOw8GQI/s1600/160x189x72+border.PNG" /></a></div>
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One treatment is to do nothing and suffer the “natural history” of measles, measles, or rubella if I should contract any of them. One treatment is to take a placebo (a do-nothing pill) and see if I have a “placebo effect” that magically prevents mumps, measles, or rubella. The treatment I am focusing on now is the MMR II vaccine. My last idea (as an unreal educated toddler) might be to look into any clinical trials that are being done on new treatments to prevent mumps, measles, and rubella.<br />
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<b>MAIN OUTCOME MEASURE – MY CHOICE</b><br />
I will one day grow up to be a strong independent woman, so I am choosing the single most important outcome measure to me: overall survival. Specifically, I am choosing “5-year overall survival.” I want to know how much my “5-year overall survival” will increase if I take the MMR II vaccine. I want to know about “absolute” increases not “relative” increases, because it is easy to exaggerate, mislead, or outright lie with relative numbers.<br />
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“There are three kinds of lies: lies, damn lies, and statistics.” – Benjamin Disraeli<br />
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“Five-year overall survival” is the best outcome measure for me, because I (the fictional toddler patient) chose it using shared decision-making with my physician, and my parents. That’s how evidence-medicine is supposed to work. Both evidence-based medicine and medical ethics say we are supposed to consider the patient’s “values and preferences.”<br />
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“When determining the optimal treatment choice based on the relative benefits and harms of a therapy, the values and preferences of each individual patient must be considered.” – Dr. Gordan Guyatt, et al. (Users' Guides to the Medical Literature: A Manuel for Evidence-Based Clinical Practice 3rd Ed. Page 71).<br />
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“Five-year overall survival” is important to me because of “the measles situation.” Measles is the most likely of the three diseases to kill me. And, when measles kills kids, it mostly kills kids who are less than 5-years-old.<br />
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“Five-year overall survival” is also a good choice because there is good data about the number of cases of mumps, measles, and rubella that have occurred in the last 5 years.<br />
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I also like “5-year overall survival” as my main outcome measure, because it’s a standard time period in medicine when it comes to other diseases such as cancer. Imagine that someone does a randomized controlled trial (RCT), and some patients get placebo pills and other patients get chemotherapy. After 5 years 95% of the patients who got chemotherapy are still alive and 0% of the patients who got placebo are still alive. That 95% difference in 5-year survival is important. That treatment really works!<br />
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One last reason to like 5-year overall survival is that there is a general body of medical literature about children from 0 to 5 years old (0 to 60 months).<br />
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<b>QUESTIONS I NEED ANSWERS TO</b><br />
Remember, I am a fictional 15-month old toddler, who is precocious, brilliant, and highly educated.<br />
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What will my 5-year overall survival be if take the MMR II vaccine?<br />
What will my 5-year overall survival be if I don’t take the MMR II vaccine?<br />
What will be the difference between the two?<br />
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<b>LIFETIME SURVIVAL</b><br />
Eventually, I really want to know “lifetime overall survival” as well as 5-year overall survival, because mumps, measles, and rubella can affect the young, the old, and the unborn, but that analysis will have to wait for a future essay.<br />
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<b>TREATMENT SCORES – WHY?</b><br />
There is an 88% health illiteracy rate (<a href="https://health.gov/communication/literacy/issuebrief/">https://health.gov/communication/literacy/issuebrief/</a>). One way to solve the health illiteracy problem is to summarize a medical treatment down to one number, the net treatment benefit for the patient, which I call the Treatment Score.<br />
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<b>SABERMETRICS</b><br />
In medicine, I often see statistics that do not put the patient first. What the patient needs to know is the net treatment benefit for them. I see all kinds of confusing statistics being given instead of what I (and you) really need to know, the NET TREATMENT BENEFIT.<br />
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A great example of the change we (all of us patients) need is Sabermetrics. Sabermetrics was invented for baseball by Bill James. Sabermetrics basically says, “Dear baseball managers, you are using the wrong statistic. This is the statistic, you should be using: runs created.” This concept helped start a revolution in baseball. We need to do the same in medicine. We need to digest all the information down to one number, the Treatment Score, which is the net benefit for the patient. (Animations can be used to show ranges and uncertainty as necessary.) You should watch the movie Moneyball, starring Brad Pitt, which is about Sabermetrics.<br />
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<b>ANALOGY - INCOME</b><br />
Think of your income. You need to know your gross income every year, but more importantly your net income:<br />
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Gross income – expenses = net income.<br />
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With medical treatments, you need to start with the “gross treatment benefit” and figure out the “net treatment benefit.”<br />
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Gross treatment benefit – side effects = net treatment benefit.<br />
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It’s more complicated with medical treatments, because there can be “side benefits” as well as negative “side effects” from a medical treatment. A medical treatment might save your life, but it also might save you from disability. So, the formula becomes:<br />
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Gross treatment benefit + side benefits – side effects = net treatment benefit.<br />
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We need to organize the numbers like this:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqU_eORFTVyyEXhjJ0vPMg7lTk7oBM2T8Wu071KsuvObpKxo7eL-u5GgxKmc8gXZEZ0dlI5x0I3JH7IrVxkWhUrswR8F3Zh1kwyE2RpQyP-wBneyfDd4c0t0uaz9Q_1OcE2j-K0OgzmD8/s1600/equation+400x400x72+1+border+1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="400" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqU_eORFTVyyEXhjJ0vPMg7lTk7oBM2T8Wu071KsuvObpKxo7eL-u5GgxKmc8gXZEZ0dlI5x0I3JH7IrVxkWhUrswR8F3Zh1kwyE2RpQyP-wBneyfDd4c0t0uaz9Q_1OcE2j-K0OgzmD8/s320/equation+400x400x72+1+border+1.png" width="320" /></a></div>
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I work in a clockwise direction. I find the “gross treatment benefit” and put it top left. I find the “positive side benefits” (green zone) and put them top right. I put the “negative side effects” (red zone) bottom right, and I calculate the net benefit at the bottom left. The net treatment benefit is what the patient needs to know. It is the most important statistic for the patient.<br />
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<b>TREATMENT SCORE CALCULATOR™</b><br />
It’s time to gather some statistics about the MMR II vaccine into the Treatment Score Calculator™ below. The main outcome measure, increase in 5-year overall survival (as a percentage) goes on the left, and the “secondary outcome measures” (also in percentages) such as positive side benefits” (green zone) and negative side effects (red zone) go on the right.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN_JxhVBIxGbXi8m8lCRVCfFFZ1VTCYnmfEwLUZu6vL0c0N1ANJJNXmVAbR63YuZkz9S991iM32mhKIvkF3QoYRPh5J6c7_TC9fM5tRJ990u8GncTOScIuuZ3vHmCTTJym7do0OnZfNNE/s1600/calculator+QUESTIONS+1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="515" data-original-width="725" height="452" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN_JxhVBIxGbXi8m8lCRVCfFFZ1VTCYnmfEwLUZu6vL0c0N1ANJJNXmVAbR63YuZkz9S991iM32mhKIvkF3QoYRPh5J6c7_TC9fM5tRJ990u8GncTOScIuuZ3vHmCTTJym7do0OnZfNNE/s640/calculator+QUESTIONS+1.png" width="640" /></a></div>
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This arrangement is the secret to understanding medical treatments. First, I organize the important statistics, and then second, I summarize them down to one number. We all need to do this for all medical treatments. We need to do this calculation using the medical literature, but also our own values and preferences. The main outcome on the top left is the same as the “gross benefit.” The top right is the “side benefits.” The bottom right is the “side effects.” The bottom left is the “net treatment benefit,” which is the same thing as the Treatment Score. Every statistic in the calculator is a percentage.<br />
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The numbers on the right come from sources available to most people on the Internet. I (your fictional toddler) searched PubMed and Google Scholar. I looked at WHO, CDC, UNICEF and FDA data and tried to find the original sources. You need to double check my numbers and improve them whenever possible. For example, I know that the side effect rate of 0.005% for “injection pain, redness, or swelling” must be too low, but I can’t find a better source. People who do studies often ignore the “small side effects” so they don’t collect good information for us patients. But as a patient, I want to know about any pain or suffering a treatment will cause me. Maybe the true number is out there somewhere, but so far, I have not found it.<br />
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<b>CALCULATION 1 – THE MAIN OUTCOME MEASURE</b><br />
The first thing we need is the increase in overall survival, which is the gross treatment benefit, and goes in the top left of our calculator. It’s a very surprising number. The increase in 5-year overall survival for me, personally, taking the MMR II vaccine is so close to zero in the USA it rounds to zero in my calculator. Other medical treatments are not like this. Vaccines are special because of their “invisible benefits.”<br />
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Look around. Do you see anyone dying of mumps, measles, or rubella? You could say that the mumps, measles, and rubella vaccine is a victim of its own success. Two of the three diseases have been “declared eliminated” from the USA.<br />
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Mumps was almost eliminated from the USA in 2000. There were only 338 reported cases in 2000.<br />
<a href="https://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html">https://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html</a><br />
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Measles was declared eliminated from the USA in 2000.<br />
<a href="https://www.cdc.gov/measles/about/faqs.html">https://www.cdc.gov/measles/about/faqs.html</a><br />
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Rubella was declared eliminated from the USA in 2004.<br />
<a href="https://www.cdc.gov/rubella/about/in-the-us.html">https://www.cdc.gov/rubella/about/in-the-us.html</a><br />
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<b>RULE OF VACCINES - 1</b><br />
The better a vaccine works the more the benefits seem to disappear.<br />
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By almost eliminating mumps, measles, and rubella from the USA, the direct overall survival benefit seems to disappear for the individual patient. If you get vaccinated, your personal overall survival will not increase but by a very tiny fraction, because the diseases mostly don’t exist.<br />
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“There have been no mumps related deaths reported in the United States during recent mumps outbreaks.”<br />
<a href="https://www.cdc.gov/mumps/hcp.html">https://www.cdc.gov/mumps/hcp.html</a><br />
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The last confirmed measles death in the USA was in 2015.<br />
<a href="https://www.doh.wa.gov/Newsroom/2015NewsReleases/15119WAMeaslesRelatedDeath">https://www.doh.wa.gov/Newsroom/2015NewsReleases/15119WAMeaslesRelatedDeath</a><br />
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One infant died from rubella in 2012.<br />
<a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a3.htm">https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a3.htm</a><br />
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<b>CALCULATION 2 – (HERD IMMUNITY DISABILITY PREVENTION)</b><br />
Catching the mumps can make you sick with fever, aches, pain, swelling of the salivary glands, tiredness, and headache. Rare serious side effects including deafness or encephalitis (inflammation of the brain) can happen.<br />
<a href="https://www.cdc.gov/mumps/hcp.html">https://www.cdc.gov/mumps/hcp.html</a><br />
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Catching measles can kill you. Measles can also cause diarrhea, ear infections, pneumonia, encephalitis, and seizures.<br />
<a href="https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html">https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html</a><br />
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Rubella causes pregnant women to lose their babies via spontaneous abortions or stillbirths (<a href="https://www.cdc.gov/rubella/about/in-the-us.html">https://www.cdc.gov/rubella/about/in-the-us.html</a>).<br />
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Rubella also causes babies to be born severely disabled with congenital rubella syndrome (CRS). These babies can have deafness, heart problems, cataracts of the eyes, mental retardation, and premature death.<br />
<a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a3.htm">https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a3.htm</a><br />
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What is the value of stopping the complications from mumps, measles, and rubella? We will come back to this number later. For now, I leave it as “not scored.”<br />
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<b>CALCULATION 3 – HERD IMMUNITY (DEATH PREVENTION)</b><br />
Preventing death is the most important thing the MMR II vaccine can do.<br />
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Herd immunity can protect our families and friends from death and disability, because we interact with them the most. It can also protect strangers and entire communities.<br />
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There is no huge randomized controlled trial (RCT) that perfectly represents the value of herd immunity in preventing death. Instead there are lower quality studies, such as cohort studies, case-control studies, and survey studies. All such studies have flaws and biases.<br />
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All survival studies need to control for the “improving nutrition” and “increasing standard of living” which occurs around the world, because those things also increase survival. We have to look for the most recent studies, but there are no perfect studies.<br />
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The best available number for the increase in overall survival for the MMR II vaccine that I could find looked at the measles vaccine alone, as measles is the deadliest of the three diseases: mumps, measles, and rubella. I could not find good survival data for all three combined.<br />
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How much have I (a toddler named Olivia) already benefitted from the herd immunity of the past 5 years? How much have I benefited in 5-year overall survival today due to the MMR II vaccine before it’s even my turn (to take it or not)?<br />
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My preferred study for all-cause mortality found a 2.4 percentage increase in the probability of a child’s survival to 60 months due the measles vaccine (<a href="http://jhr.uwpress.org/content/50/2/516.abstract">http://jhr.uwpress.org/content/50/2/516.abstract</a>). So, 2.4% was the value I put in the calculator for the side benefit of herd immunity (death prevention).<br />
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<b>ANALOGY – CURRENCY EXCHANGE</b><br />
In the graphic above, think of the main outcome measure, the “gross treatment benefit,” on the top left as being in US dollars. Then, think of the negative side effects on the lower right as being in other currencies, such as pesos, euros, rupees, and rubles. The side effect statistics are “event rates.” It’s the rate that a side effect such as fever occurs in patients after taking the MMR II vaccine (hopefully compared to unvaccinated controls).<br />
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When you go to a currency exchange, you convert one currency into another using the “exchange rate.” The exchange rate is different for every currency. The exchange rate “weights” the different currencies in order to exchange them into dollars. The same thing needs to be done with side effects to get them on the same scale as the main outcome measure. Once converted, the negative side effects can be subtracted to get to the net treatment benefit, which we call the Treatment Score.<br />
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<b>NEGATIVE SIDE EFFECT - FEVER</b><br />
The medical literature suggests that there is a 10% chance of getting a fever after the MMR II vaccine. Our main outcome is “5-year overall survival.” How do we get the side effect of fever on that scale so we can subtract it? Sometimes we can use data from studies, and we should always ask the patient. This type of thing is done in medicine - side effects are converted into things called “quality-adjusted life-years.” It’s just not done often enough, and too often the patient’s opinion does not count, but it should, because your personal opinion may be different than the average person’s.<br />
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My personal opinion is that getting a fever after an MMR II shot is not a huge negative, because it’s temporary, and can be treated. Getting a fever is “weighted” very low in terms of converting it as a side effect to be subtracted from 5-year overall survival. Five years is 60 months; 60 months is 1,825 days. I just roughly calculated that, for me, with my weighted conversion, this would only be like losing 20 minutes of survival from 5-years (43,800 hours) of overall survival.<br />
<br />
<b>NEGATIVE SIDE EFFECT – FEBRILE SEIZURE</b><br />
Getting a febrile seizure after the MMR II vaccine is more worrisome to me. I ended up putting the event rate at 0.16% (<a href="https://www.ncbi.nlm.nih.gov/pubmed/15265850">https://www.ncbi.nlm.nih.gov/pubmed/15265850</a>) into my calculator. That means about 1.6 kids out of 1,000 will have a febrile seizure. Getting a febrile seizure is worse to me than just getting a fever, so I will weight it more heavily, using my values and preferences, and subtract this negative side effect from the gross benefit of the MMR II vaccine.<br />
<br />
<b>NEGATIVE SIDE EFFECT – EPILEPSY</b><br />
Epilepsy is scary. A percentage of children get a fever. A percentage of those children have a febrile seizure. And, a percentage of those children go on to have epilepsy (seizures for life). In theory, this stair-step of complications can occur after measles, or can occur after the measles vaccine. The measles vaccine is a live attenuated vaccine, so getting the vaccine is sometimes like getting a weak case of measles. The studies I used placed this possible side effect of the MMR II vaccine at less than 1 in a million, so it shows up as zero in our calculator (we may need to fix this rounding in future versions).<br />
<br />
Any child who might be predisposed, or at genetic risk for fever, febrile seizures, or epilepsy should have special consultation before getting the MMR II vaccine. A DNA test is reportedly in the works to test for this tendency.<br />
<br />
<b>NEGATIVE SIDE EFFECTS – SERIOUS & RARE</b><br />
The bottom right of my calculator contains some potentially serious side effects of the MMR II vaccine that are so rare they round to zero. They are things like: deafness, epilepsy, brain damage, encephalitis, encephalopathy, and serious allergic reaction. They are especially rare if your control group is children who do get mumps, measles, and rubella instead of your control group being simply unvaccinated children.<br />
<br />
<b>AUTISM – THE ELEPHANT IN THE ROOM</b><br />
Does the MMR II vaccine cause autism? Maybe. Maybe not.<br />
<br />
One study, retrospective cohort study, of 537,303 children in Denmark (<a href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa021134">http://www.nejm.org/doi/pdf/10.1056/NEJMoa021134</a>) did not find a higher rate of autism in children who got vaccinated for mumps, measles and rubella.<br />
<br />
<b>TWO AUTISM CONTROVERSIES</b><br />
Who do you believe when it comes to autism as a side effect to the MMR vaccine? These two groups represent the controversies:<br />
<br />
1. Former British gastroenterologist Andrew Wakefield; Family Medicine physician Rachael Ross, MD, PhD; Pediatrician Jim Sears, MD; and CDC whistleblower Dr. William Thompson. They are all in the movie, <i>Vaxxed</i>.<br />
<br />
2. The other side of the controversy is represented by many in the three entities of Academia, Government, and Industry. One autism – vaccine paper was retracted:<br />
<a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract">http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract</a><br />
<br />
Because the side effect of autism is so hotly debated, I did not add it into my calculations. I dived deep into several studies and still did not feel certain about an “event rate” for autism. But, if in your review of the medical studies, you have found a number that you believe is accurate, you can add it into the calculations. That is the beauty of calculating the “net treatment benefit” using the patient’s own ability to understand science, and the patient’s own values and preferences. You can make calculations yourself. You can then assess the risks and benefits with your physician.<br />
<br />
<b>UNCERTAINTY IN THE NUMBERS</b><br />
This essay is a flawed first attempt to quantify the net treatment benefit for the patient from the MMR II vaccine as a Treatment Score, but it is the future. There is a lot of uncertainty in the numbers, because vaccine studies are usually not the Gold Standard: randomized controlled trials, but rather are lesser quality cohort studies, case-series studies, and survey studies. Researchers are learning from the past; however, and are doing better, and larger, studies over time.<br />
<br />
Yet, the fact remains that there is uncertainty in all the underlying numbers. There is disagreement about death rates (how often people die if they get one of these diseases) and in the negative side effect rates from the MMR II vaccine.<br />
<br />
The MAJOR POINT is that the numbers should be shared with you, and you should decide step-by-step with your physicians and nurses, which numbers come from the most credible sources. You should be able to calculate the net treatment benefit using your judgement by doing shared decision making with your doctors and nurses. That is how to do true informed consent. Part of medicine is dealing with missing data, biased data, and low-quality data.<br />
<br />
From our textbook of evidence-based medicine talking about patient decisions:<br />
<br />
“They therefore involve value and preference judgments, and it is the preferences of the individual patient that must drive the decision. When the trade-off between desirable and undesirable consequences is a close one, the best—some would argue the only—way to ensure the chosen course of action is right for the individual is through shared decision making.” - Dr. Gordon Guyatt, et al. Users' Guides to the Medical Literature: A Manuel for Evidence-Based Clinical Practice 3rd Edition. Page 83.<br />
<br />
Because of the assumptions, uncertainty, and biases in the numbers, and the difficulty in doing the “net treatment benefit” analysis this first time around, the lesson of this essay is not the specific Treatment Score, but the techniques we all need to start using to figure out the net benefits of medical treatments.<br />
<br />
<b>MEDICAL ETHICS - WHO HOLDS THE CARDS?</b><br />
Who decides the ethics? Obviously, the patient does. It’s the patient's life at stake; it’s the patient's health that is at risk. The Hippocratic Oath and the Nuremberg Code put the patient first. Decisions need to be made between the patient and physician with complete transparency: price transparency and product transparency. Product transparency means using patient-centered outcomes. Transparency also means figuring out the net treatment benefit for the patient using shared decision-making.<br />
<br />
<b>PLAYING GOD 1 - PATERNALIST MEDICINE IS BAD</b><br />
Medical ethics says playing God is bad. Patients’ values and preferences must be considered in order to be ethical. The Greatest Generation was sometimes paternalistic to patients, because there was no Internet. Patients were like children, totally dependent on doctors for their medical information. Paternalistic medicine was bad, because in the old days, mostly male doctors were telling patients what to do. This resulted in the epidemic of unnecessary hysterectomies for example.<br />
<b><br /></b>
<b>PLAYING GOD 2 – GUIDELINES AND CONVENTIONAL WISDOM</b><br />
After the Internet, paternalistic medicine underwent a shift. Instead of the individual physician telling the patient what to do, groups with “authority” and groups with “eminence” started telling physicians what to do, and then physicians told patients what to do. It became paternalism one-step removed. Once again, patients were left out.<br />
<br />
The reasoning for this “group type” of paternalist medicine was that, despite having information on the Internet, you, the patient, were felt to be incapable of understanding medical information. Experts with authority and eminence decided they must make medical decisions for you. This gave rise to “guidelines” or “conventional wisdom” provided by authorities and eminent people. Authorities and eminent people told the doctor what to do, and then the doctor told you what to do.<br />
<br />
Because unbiased randomized controlled trials (RCTs) are hard to do, we sometimes rely only on authority figures and eminent people using low quality studies. This probably led to a recent epidemic of unnecessary shoulder surgeries.<br />
<a href="http://www.thelancet-press.com/embargo/shouldersurgery.pdf">http://www.thelancet-press.com/embargo/shouldersurgery.pdf</a><br />
<br />
The reaction to “authority-biased medicine” and “eminence-biased medicine” is that patients, doctors, and nurses should be doing shared decision-making with better transparency for all. It’s a new world. I (toddler Olivia) am growing up in a STEM world. I will grow up to be independent, smart, and capable. I will utilize the best information in conjunction with the smartest doctors and nurses I can find to make my own medical decisions. My generation will help democratize medical science.<br />
<b><br /></b>
<b>CONFLICTS OF INTEREST</b><br />
I study the Conflict of Interest Declarations at the bottom of medical studies, as have my parents before me, and my grandfather before that, and we have noticed something very important. Conflict of Interest Declarations are self-delusional.<br />
<br />
Conflicts of interest are caused by money or power. The money can be direct or indirect; it can be cash or it can be goods or services. Therefore, money or power need to be disclosed whether they come from Academia, Government, or Industry. Those three entities: Academia, Government, and Industry are sometimes called the Triple-Helix, as in a medical ethics book entitled: Trust and Integrity in Biomedical Research: The Case of Financial Conflicts of Interest (Edited by Thomas H. Murray and Josephine Johnston. The Hastings Center. New York, 2010).<br />
<br />
At the end of many medical studies you see statements like these:<br />
<br />
“The author declares no conflict of interest” or<br />
“The authors declare that there are no conflicts of interest.”<br />
<br />
Search those phrases and you will find millions of examples. Medical ethics are clear that conflicts of interest in medicine are caused by three entities (in alphabetical order): 1. Academia. 2. Government, and 3. Industry.<br />
<br />
Academia is biased because they must “publish or perish,” defend the status quo, succumb to peer pressure, and so on. Government is biased because politics come into play, and because Governments are extremely powerful. When governments make a mistake, those mistakes can be huge. Need I mention the Tuskegee experiment, or later Tuskegee-like experiments? Industry can be biased because companies need to make money to survive.<br />
<br />
Almost every author’s declaration should at least say, “I have directly or indirectly been influenced by Academia, Government, or Industry.” Most declarations should be more specific and should add details that go back over the entire lifespan of the author. “Bias begins at birth” according to many medical studies.<br />
<br />
<b>HEALTH ILLITERACY & PERSPECTIVE</b><br />
We have already pointed out the 88% health illiteracy rate in the USA. Physicians have the same illiteracy problem when it comes to medical statistics. In a study of 531 physicians at teaching institutions around the world, 60% to 80% the physicians did not understand the effects of medical treatments, depending on which statistic was used<br />
(<a href="http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430">http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430</a>).<br />
<br />
Essentially, we have the blind leading the blind when it comes to medical statistics and medical treatments. We need to put patients first and fix this. We need to focus on the net treatment benefit for the patient.<br />
<br />
We need perspective. We need to know the “net treatment benefit for the patient” and we need to be able to see it. On the scale that is important to you, the patient, is the treatment near 0% or is it near 100% in terms of net benefit to you?<br />
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“The best interest of the patient is the only interest to be considered….” - William J. Mayo, M.D. – oldest Mayo brother, and one of the founders of the Mayo Clinic.<br />
<b><br /></b>
<b>FINAL CALCULATION</b><br />
Remember, the math behind the formula is:<br />
<br />
<i>Gross treatment benefit + positive side benefits – negative side effects = the net treatment benefit.</i><br />
<br />
In the future, I want each step to be transparent to you. I want you to be able to verify every statistic and its source. That would be true shared decision-making.<br />
<br />
<b>FINAL TREATMENT SCORE</b><br />
I am leaving the final Treatment Score blank for now. Vaccines are not like other medical treatments, for which it is much easier to figure out the net treatment benefit. Vaccines have side benefits of herd immunity preventing death, and herd immunity preventing disability, which are hard to put a number on. Your personal values regarding herd immunity are very important. In addition, there are more assumptions, uncertainties, and biases present in the studies I have reviewed to be comfortable summarizing the data down to one number (yet). It is much easier with other medical treatments, because it is easier to convert everything to be on the same scale, to have data from the same time period, and to be from the same geographic location. There is more objectivity with other medical treatments.<br />
<br />
<b>RULE OF VACCINES – 2</b><br />
The benefits of a vaccine are a moving target.<br />
<br />
When mumps, measles, and rubella are epidemic in a community killing people, and disabling people, it’s easier to see the benefits of the vaccine. As more and more people are vaccinated, the risks of death and disability go down. Eventually, as the vaccine causes death and disability to approach zero, the only damages left to see are the complications of the vaccine. Then, it becomes a tragedy that the disease wasn’t wiped off the face of the Earth, like smallpox was, because even a 1 in a million complication is too much. Vaccines have diminishing returns.<br />
<br />
<b>SHOULD YOU GET THE MMR II VACCINE?</b><br />
Should you get the MMR II vaccine? I would not presume to tell you what to do. I’m not going to decide for you, because it's up to you. You have to look at the data yourself and use your values and preferences to decide together with your physician. That's how evidence-based medicine, medical ethics, and shared decision-making work. I’m not going to be paternalistic.<br />
<br />
“The need for easily accessible and transparent information for patients is essential.”<br />
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337277/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337277/</a><br />
<br />
<b>WILL I GET THE MMR II VACCINE?</b><br />
I already got the MMR II vaccine. It hurt my arm, but otherwise I was fine. I was essentially an average patient. Most importantly, I understood the science because it was well organized. Using my values, my assumptions, and the best data I could find, after adding it all together, it appears the net treatment benefit is around 3% in terms of increasing 5-year overall survival. 3% more kids alive is a great thing.<br />
<br />
<b>LIMITATIONS OF THIS ESSAY</b><br />
This is deeply flawed essay, because the underlying data is from cohort studies, case control studies, and survey studies. These are low quality studies that can be subject to bias and confusion. This essay is a step in the right direction, and it will be rewritten and improved upon. This will not be the final version. In addition, I am biased to be pro-vaccine, because of the influence of “authority bias” and “eminence bias.” I tried to set my biases aside and be perfectly logical, using numbers only, but I felt my bias, because when I did calculations showing that vaccines were not as beneficial as I had imaged, I felt bad about it. It really is confusing that vaccine benefits are a moving target. Perhaps the bottom line is that we need to keep making vaccines safer and safer.<br />
<br />
“The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with the MMR vaccine cannot be separated from its role in preventing the target diseases.” – V. Demicheli, et al. “Vaccines for measles, mumps and rubella in children.” Cochrane Database Syst Rev. 2012 Feb 15;(2):CD004407.<br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/22336803">https://www.ncbi.nlm.nih.gov/pubmed/22336803</a><br />
<br />
<b>SOLUTIONS </b><br />
In the future, we will put patients first. As others have said, you are not a statistic; you are a human being. In the future, we will actually do evidence-based medicine and shared decision-making. Doctors and nurses will help patients organize the medical literature and summarize the most important treatment statistics for their disease.<br />
<br />
“An important patient right is informed consent. This means that if you need a treatment, your health care provider must give you the information you need to make a decision.” – U.S. National Library of Medicine.<br />
<a href="https://medlineplus.gov/patientrights.html">https://medlineplus.gov/patientrights.html</a><br />
<br />
<b>WE NEED A GROUP</b><br />
It’s frustrating! The entire medical system should be geared toward figuring out the “net treatment benefit” for the patient, but sadly it is not. Let’s change this. What would really would be helpful would be a credible group of patients, doctors, and nurses, who put patients first, who are not working for Academia, Government, or Industry (or who declare their bias when they are), who produce Treatment Scores that are done transparently. That way we all would not have to spend countless hours trying to understand medical treatments, and we could begin to solve the 88% health illiteracy problem.<br />
<br />
<b>THANKS </b><br />
I (Olivia, the fictional toddler!) asked questions of several experts in order to write this essay. I am thanking them here, but this does not mean that they approve of this essay or its methods. I am not mentioning names, because vaccines are a controversial subject. All the errors, misinterpretations, and assumptions are mine. This essay is only a small step in right direction of providing better treatment transparency for all.<br />
<br />
<b>OLIVIA’S CO-AUTHORS</b><br />
Bradley R. Hennenfent, M.D. (retired)<br />
Stephen Fitzmeyer, M.D.<br />
<br />
<b>FOLLOW US</b><br />
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<a href="https://twitter.com/TreatmentScores">https://Twitter.com/TreatmentScores</a><br />
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<a href="https://facebook.com/TreatmentScores">https://Facebook.com/TreatmentScores</a><br />
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<a href="https://angel.co/treatment-scores">https://angel.co/treatment-scores</a><br />
<br />
<b>DISCLAIMERS</b><br />
Treatments Scores, Inc. and associated individuals do not claim to diagnose, cure, treat, or prevent any disease. Treatment Scores are an educational system to help you figure out the science of medicine behind treatments, which should be the starting point for shared decision-making. The information on this website should never be used as a substitute for the advice of a qualified, licensed physician or healthcare professional. We are not advocating any treatment, physician, medication, or any other entity. We are informational or educational only. We do not form doctor-patient relationships. Contact your physician for medical treatment. Call 911 if you may have an emergency or go to the Emergency Department. We are not responsible for any delays in care from information obtained from our site, nor for any consequential damages of any nature whatsoever, either directly or indirectly related to the use of this site, or from assumptions made. We cannot predict the future, we are only trying to do a better job of quantifying and reviewing what has happened in the past. We claim ZERO accuracy. We claim zero accuracy, because in medicine every patient is different, every statistic is a flawed statistic in some way, there are always estimations, and there is always bad or missing data. Averages may be used and no patient is average, every patient is unique. We make no promises or warranties whatsoever. ALWAYS SEE YOUR OWN PHYSICIAN FOR DIAGNOSIS AND TREATMENT.<br />
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-44067370329874964362017-10-22T08:23:00.001-04:002018-02-07T10:20:09.541-05:00Dengue fever? The Net Treatment Benefit of the Nilavembu Kudineer herbal concoctionAccording to reports, over 150 people have died in India from an epidemic of dengue fever. No doubt, the death toll will have risen by the time you read this blog post.<br />
<br />
Dengue fever results from a virus spread by a mosquito (Aedes aegypti). Interestingly, there is a discussion going on in India over one of the alleged treatments for dengue fever called Nilavembu, which is a combination of herbs.<br />
<br />
<b>SYMPTOMS</b><br />
Dengue fever is easily mistaken for the common flu (influenza). Dengue fever can cause high fever, chills, headache, swollen glands, nausea, vomiting, aches and pains of the muscles and joints, fatigue, a rash, bruising, and so on. Dengue fever can progress in severity until it kills you. Dengue fever can turn into dengue hemorrhagic fever, which can cause severe bleeding. It’s a horrible death.<br />
<br />
Naturally, anyone near an outbreak would want a medication to prevent or cure dengue fever.<br />
<br />
<b>KAMAL HAASAN</b><br />
The famous actor and director, Kamal Haasan, reportedly tweeted:<br />
<b>“Till proper research results come let us not distribute Nilavembu concoction.”</b> (Note, when I search Twitter I cannot find this tweet, but it might have been deleted, because of the ensuing controversy, or might not be searchable from the USA.)<br />
https://www.ndtv.com/tamil-nadu-news/no-medicine-without-doctors-advice-kamal-haasan-on-dengue-treatment-1764890<br />
<br />
<b>GOVERNMENT</b><br />
The local Health Minister said: <b>“Nilavembu is a proven medicine, we have tested it in King Institute in Guindy, it increased the platelets and immunity, it is proven…..”</b><br />
http://www.india.com/news/india/dengue-menace-kamal-haasan-tamil-nadu-government-trade-punches-over-nilavembu-kudineer-complaint-filed-against-actor-2545942/<br />
<br />
The “…Director of Public Health and Preventive Medicine, said, <b>‘There's tacit knowledge, for thousands of years our ancestors have huge knowledge. If you ask of scientific evidence, how come several drugs get banned after being used for several years?’</b>”<br />
https://www.ndtv.com/tamil-nadu-news/no-medicine-without-doctors-advice-kamal-haasan-on-dengue-treatment-1764890<br />
<br />
<b>MEDICAL STUDIES</b><br />
What do medical studies say? I searched the medical literature on treating dengue fever with the herbal preparation Nilavembu Kudineer, added them up, and came up with a Treatment Score of zero. Zero in this case meaning there is no data. I could not find any studies with human beings that gave treatment effects showing Nilavaembu Kudineer to be effective at either treating or preventing dengue fever.<br />
<br />
<b>GRAPHIC</b><br />
The graphic shows the final result. In the software, you can click through the graphic to get all the original data.<br />
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<b>HOW I DID THE TREATMENT SCORE</b><br />
To come up with the Treatment Score, I searched PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and only found two medical studies on Nilavembu. One study was in mice, and one study was "in silico," which means a laboratory study using computers that have silicon chips. There were no human studies. I also search the medical literature via the Trip Database (https://www.tripdatabase.com) and found zero studies of "quality" for Nilavembu. In addition, I searched Google Scholar, and while finding some interesting non-human studies, I found no human studies.<br />
<br />
<b>THIS REVIEW MAY BE FLAWED</b><br />
If anyone knows of any important HUMAN studies on Nilavembu, please let me know. There may be studies in Indian medical journals to which I do not have access. Please review and critique this review, and suggest other studies that need to be considered. One good quality study would change the Treatment Score. I would love to collaborate. Let’s work together.<br />
<br />
<b>BETTER STUDIES</b><br />
Ideally, quintuple blinded, randomized controlled trials need to be done comparing the Nilavembu Kudineer herbal concoction with placebo. It would be great if Kamal Haasan collaborated with the government to get studies done. If Nilavembu Kudineer proved to be effective in randomized controlled trials at either prevention or cure of dengue fever it would be a major discovery. Sometimes herbal therapies hold up in experimental studies. We all need to know, because science is how new and better treatments are discovered.<br />
<br />
<b>WORLD NEEDS TO WORK TOGETHER</b><br />
Patients, doctors, nurses, and journalists around the world need to start working together to create better treatment transparency. We all need to be better science communicators. We can do this using Treatment Scores. The Treatment Score = the net treatment benefit for the patient, as summarized from the existing medical literature.<br />
<br />
<b>HERBAL PREPARATIONS</b><br />
One of the problems with studying herbal preparations is that they often have many names and different ingredients. This means they often have different doses of the different ingredients. For example, Nilavembu Kudineer may also be called Nilavembu Kashayam, or Nilavembu Kudineer Choornam (Churna). It’s not entirely clear.<br />
<br />
<b>NINE INGREDIENTS </b><br />
One website lists the ingredients of Nilavembu Kudineer, if it is the same product as Nilavembu Kudineer Choornam (Churna), which I have quoted below:<br />
<br />
<b>“Nilavembu Kudineer Choornam (Churna) contains nine ingredients mixed in equal proportion in powdered form.” </b><br />
https://www.ayurtimes.com/nilavembu-kudineer-nilavembu-kashayam/#ingredients-composition<br />
<br />
I have created a numbered list of the ingredients from that website:<br />
<br />
<ol>
<li>Nilavembu (Kalmegh, Bhunimba or Indian Echinacea) - Andrographis Paniculata</li>
<li>Vilamichai Ver - Plectranthus Vettiveroides</li>
<li>Vetiver (Ushira or Khas) - Vetiveria Zizanioides</li>
<li>Chukku - Sonth - Zingiber Officinale</li>
<li>Milagu - Kali Mirch (Black pepper) - Piper Nigrum</li>
<li>Korai Kizhangu - Mustak (Nut Grass) - Cyperus Rotundus</li>
<li>Santanam - Safed Chandan (White Sandalwood) - Santalum Album</li>
<li>Peyputtal (Chichonda) - Trichosanthes Cucumerina (Snake Gourd)</li>
<li>Parpadagam - Mollugo Cerviana</li>
</ol>
<br />
<b>SIDE EFFECTS</b><br />
When I calculated the Treatment Score for Nilavembu Kudineer, I could not find any statistics for the side effects. Specifically, I found no “event rates” for any side effects. These studies need to be done, if they have not been done. The side effect of infertility is interesting, because it may not be a side effect at all, but may possibly be an Internet rumor - another reason why high quality studies are needed.<br />
<br />
<b>CONCLUSION</b><br />
The Treatment Score for Dengue fever for Nilavembu Kudineer = Zero = No Data. High-quality clinical studies need to be done. Patients, doctors, nurses, and journalists need to become better science communicators by using evidence-based medicine<br />
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Patients are suffering because they cannot understand complex medical studies. Patients need understandable treatment transparency. If you want to learn about Treatment Scores and help patients, please contact me at:<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
<b>DISCLAIMERS</b><br />
Treatments Scores, Inc. and associated individuals do not claim to diagnose, cure, treat, or prevent any disease. Treatment Scores are an educational system to help you figure out the science of medicine behind treatments, which should be the starting point for shared decision-making for all diagnoses. The information on this website should never be used as a substitute for the advice of a qualified, licensed physician or healthcare professional. We are not advocating any treatment, physician, medication, or any other entity. We are informational or educational only. We do not form physician-patient or doctor-patient relationships. Contact your physician for medical treatment. Call 911 if you may have an emergency or go to the Emergency Department. We are not responsible for any delays in care from information obtained from our site, nor for any consequential damages of any nature whatsoever, either directly or indirectly related to the use of this site, or from assumptions made. We cannot predict the future, we are only trying to do a better job of quantifying and reviewing what has happened in the past. We claim ZERO accuracy. We claim zero accuracy, because in medicine every patient is different, every statistic is a flawed statistic in some way, there are always estimations, and there is always bad or missing data. Averages may be used and no patient is average, every patient is unique. We make no promises or warranties whatsoever. SEE YOUR OWN PHYSICIAN FOR TREATMENT.<br />
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Copyright © 2017 All rights reserved.<br />
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-72011000851793434762017-09-07T14:07:00.000-04:002018-02-07T10:22:15.275-05:00Should You Take a Statin? What is the Net Treatment Benefit?<b>Should you take a statin to prevent your death?</b> Let’s assume you are a 66-year-old person with a normal cholesterol level (of about 186 mg/dl) and you want to know if you will live longer if you take a statin.<br />
<br />
Let’s add the condition that you have an elevated high-sensitivity C-reactive protein level (of about 4.2 mg/liter). C-reactive protein is a measure of inflammation in the human body. High-sensitivity C-reactive protein (hsCRP) might be more highly associated with causing disease than regular C-reactive protein (CRP).<br />
<br />
Under these conditions, if you take rosuvastatin (Crestor) 20 milligrams for 2 years, will you live longer? Will side effects bother you? Will you have a net positive benefit?<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_mloJobKcYaCyDUr2yttOq2N2umE8fg0_azRwDoASDOexEBsOrjQb9QD_RisKkF6NyX3M4fW8QZJq3SeM1bqQxxJVuWCfBA-0234CHhmVggAmfoALQX_Z47I4xr1WY5FYNV6y2fW8ONA/s1600/logo+100x100x72.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="100" data-original-width="100" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_mloJobKcYaCyDUr2yttOq2N2umE8fg0_azRwDoASDOexEBsOrjQb9QD_RisKkF6NyX3M4fW8QZJq3SeM1bqQxxJVuWCfBA-0234CHhmVggAmfoALQX_Z47I4xr1WY5FYNV6y2fW8ONA/s1600/logo+100x100x72.png" /></a></div>
<br />
<b>The Treatment Score = the net treatment benefit for the patient as summarized from the existing medical literature.</b> Treatment Scores incorporate the ideals of treatment transparency, evidence-based medicine, shared-decision making, patient engagement, patient safety, personalized medicine, and patient empowerment. It’s especially important to personalize the Treatment Score to your preferences.<br />
<br />
In order to solve the health illiteracy problem, we all need to start explaining treatments in three ways:<br />
<br />
<ol>
<li>The Treatment Score</li>
<li>The proportion</li>
<li>The Number Needed to Treat based on the Treatment Score</li>
</ol>
<br />
One way of looking at taking rosuvastatin (Crestor) 20 mg is this:<br />
<br />
<ol>
<li>The Treatment Score is less than 1%. In fact, the Treatment Score is less than 0.01%.</li>
<li>Less than 1 person like me out of a 100 will benefit. In fact, only about 1 person out of 2,000 will benefit.</li>
<li>The Number Needed to Treat for the net benefit is 1,818, which means you need to treat 1,818 patients to get 1 patient to benefit.</li>
</ol>
<br />
<b>THE TREATMENT SCORE</b><br />
I started with a gross overall survival treatment benefit of 0.55% from the Jupiter Trial. Then, after subtracting the negative side effects I arrived at a Treatment Score of 0.055% for someone with my preferences.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidTvDzbVABGtjrqXONwfZgx551aIINk22Z4f1Njy-bHGyrs5MCgdvMiltW-vkIs8rR99HzAyxiAAL1EoTpUwQ3v9ytV9_KCfR0-7Zu1MZGmZlPZrwO3JAuTJeoplINqcAuVuiQkM7BmAI/s1600/20170902+gross+net+BORDER.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="253" data-original-width="307" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidTvDzbVABGtjrqXONwfZgx551aIINk22Z4f1Njy-bHGyrs5MCgdvMiltW-vkIs8rR99HzAyxiAAL1EoTpUwQ3v9ytV9_KCfR0-7Zu1MZGmZlPZrwO3JAuTJeoplINqcAuVuiQkM7BmAI/s1600/20170902+gross+net+BORDER.png" /></a></div>
<br />
Note that I weighted the 8 negative side effects heavily before subtracting them, because of my personal experiences. Another person would weight them differently. That math is not being show here for simplicity’s sake, but personalized medicine is an important part of Treatment Scores.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7TZ78Edlav2vK4udSLXgq0M_4auE8yoA2dGioQ12tmsFJm4Ihyphenhypheni4KerMfdBEYpY5bUjDRaq-CMKFUZLkD6H907SFSA8kmPNGWPuxEfQklkO7V8h8ockYQ3dBpQel6IQ3YaIVpraXu20/s1600/20170902+score+after+side+effects+BORDER+3.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="261" data-original-width="638" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7TZ78Edlav2vK4udSLXgq0M_4auE8yoA2dGioQ12tmsFJm4Ihyphenhypheni4KerMfdBEYpY5bUjDRaq-CMKFUZLkD6H907SFSA8kmPNGWPuxEfQklkO7V8h8ockYQ3dBpQel6IQ3YaIVpraXu20/s640/20170902+score+after+side+effects+BORDER+3.png" width="640" /></a></div>
<br />
<b>THE NUMBER NEEDED TO TREAT</b><br />
The Number Needed to Treat (NNT) was invented back in the 1980’s. However, it has always been a seriously flawed statistic because it is not what the patient needs to know. The <b>Number Needed to Treat based on the Treatment Score</b> is much more meaningful to the patient.<br />
<b><br /></b>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuWHWlon4p5vjHjqpNFiRoKPJV5xtelNaduIEj10AFylDaIkQKrMf08cO3geboyzssQHubqo9E8teC9sg94fw6rG2p0hUe2LurdfVJiek9ItEYvYYZWIE_JVy85F9jZPEG1lWwj6VRWKk/s1600/BEST+150x189x72+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="189" data-original-width="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuWHWlon4p5vjHjqpNFiRoKPJV5xtelNaduIEj10AFylDaIkQKrMf08cO3geboyzssQHubqo9E8teC9sg94fw6rG2p0hUe2LurdfVJiek9ItEYvYYZWIE_JVy85F9jZPEG1lWwj6VRWKk/s1600/BEST+150x189x72+1.png" /></a></div>
<b><br /></b>
<b>CANS OF FOOD</b><br />
Medical treatments are like cans of food without labels. With Treatment Scores, we are putting labels on these blank cans so they can be better assessed. With Treatment Scores, we can organize lists of treatments with Treatment Scores, so that all the treatments are evaluated with the same outcome measure, over similar time periods, and with similar patient populations.<br />
<br />
<b>EXPERTS </b><br />
Other physicians have found concerns after reviewing the medical literature on statins. I want to recognize Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?” In his blog, he writes:<br />
<br />
“Results: 6 studies for primary prevention and 5 for secondary prevention with a follow-up between 2.0 and 6.1 years were identified. Death was postponed between −5 and 19 days in primary prevention trials and between −10 and 27 days in secondary prevention trials. The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.”<br />
<br />
Basically, when you look at statins from the patients’ point of view, which is the important point of view, statins do not necessary do well in terms of their “net treatment benefit.”<br />
<br />
You might want to read this by Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No.”<br />
https://www.medpagetoday.com/cardiology/prevention/20948<br />
<br />
Michel de Lorgeril, MD and others wrote: “Clearly, the time has come for a critical reappraisal of cholesterol-lowering and statin treatments….”<br />
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101<br />
<br />
Also read: Ben Spencer, "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors," The Daily Mail. 24 November, 2016.<br />
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58<br />
<br />
From another article: "Students and pharmacists investing a small amount of time in 'studying a study' and applying the principles of interpreting clinical research could come up with markedly different views of the therapeutic value of a drug than that reported in the general media." [Typo fixed]<br />
"Analysis of the Rosuvastatin (Crestor) Jupiter Trial." April 6, 2009.<br />
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/<br />
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<b>DISCLAIMERS</b><br />
You must always see a licensed physician for diagnosis and treatment. You cannot use Treatment Scores to diagnose or treat yourself. Treatment Scores are only an informational exercise. Death or permanent disability can result if you don't see your own medical physician. Death or permanent disability can result if you don’t call an ambulance or go to the emergency department immediately for emergency or urgent medical issues. We claim no accuracy for Treatment Scores, because the underlying medical studies can be wrong or the methods can be wrong. You must always see your own physician. We make no promises, claims, or warranties whatsoever.<br />
<br />
<b>REFERENCES & SOURCES:</b><br />
Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?”<br />
https://drmalcolmkendrick.org/2015/10/27/how-much-longer-will-you-live-if-you-take-a-statin/<br />
<br />
Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No,”<br />
MedPage Today, June 28, 2010.<br />
https://www.medpagetoday.com/cardiology/prevention/20948<br />
<br />
Michel de Lorgeril, MD; Patricia Salen, BSc; John Abramson, MD; et al Sylvie Dodin, MD; Tomohito Hamazaki, PhD; Willy Kostucki, MD; Harumi Okuyama, PhD; Bruno Pavy, MD; Mikael Rabaeus, MD. "Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy: A Critical Reappraisal." Arch Intern Med. 2010;170(12):1032-1036. doi:10.1001/archinternmed.2010.184.<br />
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101<br />
<br />
Ben Spencer. "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors" The Daily Mail. 24 November, 2016.<br />
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58<br />
<br />
Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., and Robert J. Glynn, Sc.D., for the JUPITER Study Group.<br />
"Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein." N Engl J Med 2008; 359:2195-2207November 20, 2008DOI: 10.1056/NEJMoa0807646<br />
http://www.nejm.org/doi/full/10.1056/NEJMoa0807646<br />
<br />
"Analysis of the Rosuvastatin (Crestor) Jupiter Trial." April 6, 2009.<br />
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/<br />
<br />
FDA.gov Drug Data<br />
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021366s016lbl.pdf<br />
<br />
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-5368146768382570392017-08-24T10:15:00.000-04:002018-02-07T10:08:42.191-05:00Are Prescribed Statins a Good Idea for Patients with Normal Cholesterol? by Stephen Fitzmeyer, M.D.This is the first of a series of blog posts that will use the TreatmentScores.com application to verify or debunk treatment claims, studies, and gossip.<br />
<br />
This week's topic received a Treatment Score of -0.1.<br />
<br />
Half of all heart attacks and strokes happen in apparently healthy people with LDL cholesterol levels below the current recommended level. So, we asked: "If your cholesterol is normal, can taking statins reduce your risk of death from heart disease or stroke?"<br />
<br />
Cardiologist Dr. Paul Ridker, a professor of medicine at Harvard Medical School, the lead scientist on the landmark JUPITER trial, showed that statins, specifically rosuvastatin, might offer a substantial benefit to people with normal or even low levels of cholesterol.<br />
<br />
In the JUPITER trial they "randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes." We focused on Overall Survival to calculate the Treatment Score, because it is the hardest, most objective endpoint.<br />
<br />
We plugged several studies' statistical results into the Treatment Score Calculator(TM), added negative side effects, and came up with a not-so-great Treatment Score of -0.1.<br />
<br />
Our original gross Treatment Score for Overall Survival was 0.55, as in an increase in overall survival of 0.55% at 2 years, which equates to a grade of 'E'. However, the risk of complications from negative side effects lowered that score to -0.1.<br />
<br />
Of greatest concern was the increased risk of developing diabetes or rhabdomyolysis, which suggests that preventative rosuvastatin is not worth the trade-off.<br />
<br />
Negative side-effects we scored: constipation, diabetes, headache, myalgia, myopathy, nausea, rhabdomyolysis, tendinopathy, and weakness.<br />
<br />
In the next article I will look into studies that claim lowering homocysteine levels in the blood can prevent heart disease.<br />
<br />
Stephen Fitzmeyer, MD<br />
Dr. Fitzmeyer is a Physician Informaticist with advanced post-doc training in medical informatics from Boston University/Boston Medical Center and the Boston VA Healthcare System.<br />
<br />
<strong>SOURCES:</strong><br />
N Engl J Med. 2008 Nov 20;359(21):2195-207. doi: 10.1056/NEJMoa0807646. Epub 2008 Nov 9.<br />
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.<br />
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group.<br />
<br />
Link to abstract: <a href="https://www.ncbi.nlm.nih.gov/pubmed/18997196">https://www.ncbi.nlm.nih.gov/pubmed/18997196</a><br />
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<strong>DISCLAIMER</strong><br />
You must always see a licensed physician for diagnosis and treatment. You cannot use Treatment Scores to diagnose or treat yourself. Treatment Scores are only an educational exercise. Death or permanent disability can result if you don't see your own medical physician. Death or permanent disability can result if you don’t call an ambulance or go to the emergency department immediately for emergency or urgent medical issues. We claim no accuracy for Treatment Scores, because the underlying medical studies can be wrong or the methods can be wrong. You must always see your own physician. We make no promises, claims, or warranties whatsoever.<br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-75493844852625629432017-06-23T19:22:00.000-04:002018-02-07T10:25:41.542-05:00Help Patients! Create Treatment Transparency<b>We can help patients by speaking out about the need for better treatment transparency. </b>Patients, and patient advocates, want these four deadly problems solved:<br />
<ol>
<li>There is an 88% health illiteracy rate among patients (Health.gov)</li>
<li>60 to 80% of physicians don't understand treatment effects (CMAJ)</li>
<li>The Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”</li>
<li>PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”</li>
</ol>
We have created the solution for all four problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. Treatment Scores put patients first by summarizing medical studies from the patient's point of view.<br />
<br />
<b>How to explain Treatment Scores?</b> We figure out our “gross income” and “net income” when we do our income taxes. Why can't we figure out the “gross treatment benefit” and the “net treatment benefit” for patients from the medical literature? It is simple with Treatment Scores technology.<br />
<br />
Did you see the movie “Moneyball” about Sabermetrics starring Brad Pitt? Treatment Scores are “Sabermetrics for medicine.” Sabermetrics have revolutionized sports. Treatment Scores will revolutionize healthcare for the same reason, because like Sabermetrics, Treatment Scores reduce disorganized data down to one number.<br />
<br />
<b>Patients are suffering from health illiteracy, under-treatment, over-treatment, and even mistreatment, because they cannot understand complex medical studies.</b> Patients need understandable treatment transparency. If you are interested in helping patients, and you read medical studies, please contact me at<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
My colleagues and I would like to speak with you, but first read on for more information.<br />
<br />
Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM). In the early days of the computer, you had to know how to use machine language to use a computer. Once Windows and Apple put a GUI over machine language everyone could use a computer. Similarly, with Treatment Scores, everyone can do evidence-based medicine.<br />
<br />
Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: evidence-based medicine in a format that saves time. Bloggers and writers can bring treatment transparency out of the dark ages.<br />
<br />
<b>REVELATIONS</b><br />
When you do Treatment Scores you can make some astonishing discoveries.<br />
<br />
The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.<br />
<br />
Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, having a Treatment Score of 95% (as in 95% cure rate) for some patients, compared to the old interferon based protocol that has a Treatment Score of 40%.<br />
<br />
Steve Jobs (of Apple) allegedly had pancreatic cancer (stage 1, neuroendocrine type) found by accident. No doubt, such a smart, wealthy CEO would immediately undergo the "most scientific treatment" for this most curable form of all pancreatic cancers, right? No! Remember, there is an 88% health illiteracy rate among patients (Health.gov). Even “the genius” Steve Jobs wasted precious time, apparently 6 months or more, doing treatments that were not backed by clinical evidence. How many times did his cancer double in size over the 180-day delay? Doubling time can be as low as 62 days (Pancreas, 2001). Would Steve Jobs still be alive today if he had simply had immediate access to a list of all possible treatments with Treatment Scores? His cancer reportedly spread beyond his pancreas (became metastatic) and he passed away.<br />
<br />
<b>A COMPLETE LIST OF TREATMENTS</b><br />
Patients need a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the sub-classes of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here is how the Treatment Score changes depending on your personal preferences.<br />
<br />
Patients want to know the science behind treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments effects are zero. You can even tell patients when the Treatment Score is negative (harmful).<br />
<br />
<b>LOOKING</b><br />
We are looking for a person (or a group of people) who want to help patients with treatment transparency using Treatment Scores. This is a great educational opportunity (over the Internet), and there are many uses for Treatment Scores in healthcare and business.<br />
<b><br /></b>
<b>AUDIENCE</b><br />
If you volunteer with us, the essays you blog or write with Treatment Scores will be seen by a wide audience. We have over 150,000 followers on Facebook, over 9,750 followers on Twitter. As I write this, we hold all top 10 positions on Google search, and we are growing by over 1,500 followers per day on all our social media accounts combined. Patients clearly want better treatment transparency.<br />
<br />
You could write for your hometown newspaper or for major publishers. Everyone needs Treatment Scores. You could become a spokesperson for patients, for treatment transparency, evidence-based medicine, shared-decision making, patient engagement, patient safety, and patient empowerment.<br />
<br />
<b>LEARNING</b><br />
You will receive an extraordinary education in evidence-based medicine. You will discover amazing revelations hidden in the medical literature. You will find scoop after scoop that can “go viral” as there is so little treatment transparency right now.<br />
<br />
<b>CONTACT</b><br />
If you are interested in Treatment Scores, please email:<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
There is a 1-minute explainer video about Treatment Scores on YouTube:<br />
<a href="https://youtu.be/GLIIB3oOVJA">https://youtu.be/GLIIB3oOVJA</a><br />
<br />
There is an explanatory essay about Treatment Scores and Smart Phones here:<br />
<a href="http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html">http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html</a><br />
<br />
Bradley R. Hennenfent, MD<br />
Physician & Economist (Retired)<br />
United States<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
<b>ABOUT</b><br />
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.<br />
<br />
To support Treatment Scores and the treatment transparency movement:<br />
<br />
<b>FOLLOW FACEBOOK:</b><br />
<a href="https://www.facebook.com/TreatmentScores">https://www.facebook.com/TreatmentScores</a><br />
<br />
<b>FOLLOW TWITTER:</b><br />
<a href="https://twitter.com/TreatmentScores">https://twitter.com/TreatmentScores</a><br />
<br />
<b>FOLLOW THIS BLOG</b><br />
Follow this blog by submitting your email address into the box near the top right.<br />
<b><br /></b>
<b>DISCLAIMER</b><br />
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues. We claim no accuracy for Treatment Scores because the underlying medical studies can be wrong, or the methods can be wrong. You must always see your own physician.<br />
<br />
<b>SOURCES</b><br />
America's Health Literacy: Why We Need Accessible Health Information<br />
https://health.gov/communication/literacy/issuebrief/<br />
<br />
Do clinicians understand the size of treatment effects? A randomized survey across 8 countries<br />
http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430<br />
<br />
Patient-Centered Outcomes Research Institute<br />
http://www.pcori.org/assets/FINAL-PFA-Communication-and-Dissemination-v3.pdf<br />
<br />
<b>COPYRIGHT</b><br />
Copyright © 2017 Bradley R. Hennenfent, M.D. All rights reserved.<br />
<br />
<br />
<br />
<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com1tag:blogger.com,1999:blog-3721609999509837563.post-43293182005351655302017-06-19T10:26:00.000-04:002018-02-07T10:09:48.204-05:00Help Patients: Blog and Write with Treatment Scores<b>Patients, and patient advocates, DESPERATELY need these five horrendous problems solved:</b><br />
<br />
1.<span class="Apple-tab-span" style="white-space: pre;"> </span>There is an 88% health illiteracy rate among patients (Health.gov)<br />
2.<span class="Apple-tab-span" style="white-space: pre;"> </span>60 to 80% of physicians don't understand treatment effects (CMAJ)<br />
3.<span class="Apple-tab-span" style="white-space: pre;"> </span>The Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”<br />
4.<span class="Apple-tab-span" style="white-space: pre;"> </span>PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”<br />
5.<span class="Apple-tab-span" style="white-space: pre;"> </span>The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).<br />
<br />
We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to help patients understand medical treatments.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimlnSqqHyHI1mMLMFwyNyxKjKNYo7FrwXMc6Pqi1HkkRYXyBYiyjym5zLmhhwc7P2mG2I34bjmXL1go-BHqrbKJBtOB9QKfwL5WKWQM0kJkXxXNzaHUcK_14z10d4YC-JemRErb716a1c/s1600/help+patients+150x150x100+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="150" data-original-width="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimlnSqqHyHI1mMLMFwyNyxKjKNYo7FrwXMc6Pqi1HkkRYXyBYiyjym5zLmhhwc7P2mG2I34bjmXL1go-BHqrbKJBtOB9QKfwL5WKWQM0kJkXxXNzaHUcK_14z10d4YC-JemRErb716a1c/s1600/help+patients+150x150x100+1.png" /></a></div>
<br />
Patients are suffering from health illiteracy, medical scams, under-treatment, over-treatment, mistreatment, and being lied to with statistics. It’s horrible right now.<br />
<br />
How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our income taxes. So, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9fl0wTkyj0eynDK044y8irK1pgCGY2wn57zdEhDbeEzgka8YDp0kRT2fjHh-o6UYo_0IdKgpb39v-z9GsIzuI-VWZ0JIfPFFSYEy6OM637NPmVJUZwz5ExYDwZAXgLU1JtbZXuF1ZoWY/s1600/treatment+scores+150x150x100+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="150" data-original-width="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9fl0wTkyj0eynDK044y8irK1pgCGY2wn57zdEhDbeEzgka8YDp0kRT2fjHh-o6UYo_0IdKgpb39v-z9GsIzuI-VWZ0JIfPFFSYEy6OM637NPmVJUZwz5ExYDwZAXgLU1JtbZXuF1ZoWY/s1600/treatment+scores+150x150x100+1.png" /></a></div>
<br />
Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM). In the early days of the computer, you had to know how to use machine language to use a computer. Once Windows and Apple put a GUI over machine language everyone could use a computer. We have put a GUI over evidence-based medicine (EBM) so that everyone can do EBM.<br />
<br />
Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: Evidence-Based Medicine in a format that saves time. Bloggers and writers can stop lying with statistics.<br />
<br />
<b>REVELATIONS</b><br />
When you do evidence-based medicine (EBM) with a graphical user interface (GUI), and you quantify the effects of medical treatments, you can make some astonishing discoveries.<br />
<br />
A colleague looked at the trend not to give antibiotics to children under 2 years of age who present with ear aches (otitis media). He calculated a Treatment Score of 10% for symptom resolution for giving amoxicillin. He was surprised, because he thought the Treatment Score would be much higher. On the other hand, why withhold any treatment that has a “net treatment benefit” of 10% for resolving symptoms? It should be up to the patient. Patients want to know all the choices and all the information about each treatment; they want shared-decision making, because personal preferences can change the Treatment Score.<br />
<br />
The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.<br />
<br />
Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, having a Treatment Score of 95% (as in 95% cure rate), compared to the old interferon based protocol that has a Treatment Score of 40%.<br />
<br />
The Xiao procedure for incontinence in children with spina bifida has been reported as being 80% successful in some studies. When evidence-based medicine is applied and biased are removed the Treatment Score = 0% (or even turns negative because of harm from the surgery).<br />
<br />
Steve Jobs (of Apple) allegedly had stage 1, neuroendocrine, pancreatic cancer found by accident. No doubt, such a smart, wealthy CEO would immediately undergo the "best treatment" for this most curable form of all pancreatic cancers, right? No! Remember, there is an 88% health illiteracy rate among patients (Health.gov). Even “the genius” Steve Jobs wasted precious time, apparently 6 months or more, doing treatments that were not backed by clinical evidence. How many times did the tumor double in size over the 180-day delay? Doubling time can be as low as 62 days (Pancreas, 2001). Would Steve Jobs still be alive today if he had simply had immediate access to a list of all possible treatments with Treatment Scores? His disease reportedly became metastatic and he passed away.<br />
<br />
<b>A COMPLETE LIST OF TREATMENTS</b><br />
Patients want a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the sub-classes of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here are how the Treatment Scores change depending on your personal preferences.<br />
<br />
Patients want to know about all treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments don’t work. You can even tell patients when the Treatment Score is negative (harmful).<br />
<br />
<b>LOOKING</b><br />
We are looking for a person (or a group of people) who can help lead the movement for treatment transparency using Treatment Scores. We are looking for people passionate about patient education, shared decision-making, patient engagement, patient empowerment, and personalized medicine. This will be a great educational opportunity (over the Internet).<br />
<br />
<b>AUDIENCE</b><br />
The essays you write with Treatment Scores will be seen by a wide audience. We have over 100,000 followers on Facebook, over 9,000 followers on Twitter, and we hold all top 10 positions on Google search. As I write this, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency. You can also write for your hometown newspaper and prove to your local community that, with technology, you are the smartest patient advocate in town. Major publishers also need Treatment Scores.<br />
<br />
<b>LEARNING</b><br />
What will Treatment Scores give you besides worldwide and local publicity? You will receive an extraordinary education in evidence-based medicine. You will discover amazing revelations currently hidden in the medical literature. You will find “scoops” and information that needs to “go viral.”<br />
<br />
If you want to help patients, you should be interested in social media: Facebook, Twitter, YouTube, and blogging. You should not be afraid of appearing on TV, and you should be good with a smart phone.<br />
<br />
<b>IMAGINE A FUTURE</b><br />
Imagine a future where patients actually understand evidence-based medicine and where treatment transparency disrupts the entire medical industry.<br />
<br />
<b>CONTACT</b><br />
If you are interested in Treatment Scores, please email:<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
Feel free to send your LinkedIn profile, CV, or any other information.<br />
<br />
There is a 1 minute explainer video about Treatment Scores on YouTube:<br />
<a href="https://youtu.be/GLIIB3oOVJA">https://youtu.be/GLIIB3oOVJA</a><br />
<br />
There is an explanatory essay about Treatment Scores and Smart Phones here:<br />
<a href="http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html">http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html</a><br />
<br />
Bradley R. Hennenfent, MD<br />
Physician & Economist (Retired)<br />
Florida, USA<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
<b>ABOUT</b><br />
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.<br />
<br />
To support Treatment Scores and the treatment transparency movement:<br />
<br />
<b>FOLLOW FACEBOOK:</b><br />
<a href="https://www.facebook.com/TreatmentScores">https://www.facebook.com/TreatmentScores</a><br />
<br />
<b>FOLLOW TWITTER:</b><br />
<a href="https://twitter.com/TreatmentScores">https://twitter.com/TreatmentScores</a><br />
<b><br /></b>
<b>FOLLOW THIS BLOG</b><br />
Follow this blog by submitting your email address into the box near the top right.<br />
<br />
<b>DISCLAIMER</b><br />
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues.<br />
<br />
Copyright © 2017 All rights reserved.<br />
<div class="MsoNormal">
<span style="font-family: "calibri" , sans-serif; font-size: 10.0pt;"><br /></span>
<span style="font-family: "calibri" , sans-serif; font-size: 10.0pt;">EBM® Treatment Scores<o:p></o:p></span></div>
<span style="font-family: calibri, sans-serif; font-size: 10pt;">SOM® Treatment Scores</span><br />
<br />BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com1tag:blogger.com,1999:blog-3721609999509837563.post-54811720199757513382017-06-12T08:47:00.000-04:002018-02-07T10:10:17.018-05:00Teach the World Evidence-Based Medicine (Help Patients!)<b>Teach the world evidence-based medicine</b>, because patients and patient advocates, DESPERATELY want these five horrendous problems solved:<br />
<br />
1.<span class="Apple-tab-span" style="white-space: pre;"> </span>There is an 88% health illiteracy rate among patients (Health.gov)<br />
2.<span class="Apple-tab-span" style="white-space: pre;"> </span>60 to 80% of physicians don't understand treatment effects (CMAJ)<br />
3.<span class="Apple-tab-span" style="white-space: pre;"> </span>The Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”<br />
4.<span class="Apple-tab-span" style="white-space: pre;"> </span>PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”<br />
5.<span class="Apple-tab-span" style="white-space: pre;"> </span>The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ-fCpcTkv0SZhsUhZsA4hBTE5_GAqb1O7oK1t9T6OR5bMCORc_7BLyFexEieU1jgXLsc3_PtE80B4so-k8gw2P7giAIMuN4N1EppDeqhhPPa2y0WdHOMR7K2WtDEH6jxXLWG2GDtUarc/s1600/teach+ebm+150x150x100+border+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="150" data-original-width="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ-fCpcTkv0SZhsUhZsA4hBTE5_GAqb1O7oK1t9T6OR5bMCORc_7BLyFexEieU1jgXLsc3_PtE80B4so-k8gw2P7giAIMuN4N1EppDeqhhPPa2y0WdHOMR7K2WtDEH6jxXLWG2GDtUarc/s1600/teach+ebm+150x150x100+border+1.png" /></a></div>
<br />
We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to help patients (and everyone) understand medical treatments.<br />
<br />
How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our income taxes. So, for patients, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXMu9AMAZklql3jhRdOz_hi6Lr35iL8HcLesn3ZGll1aqZFD2E8w4hk6lLl2Fw3p2w49LsgiNSEUonpx0vT2hlFuWlCglFAuwcDf3ddTcXrRDWtCHW3d3Mawe46PyAzv7t5KAKq2Y9wQw/s1600/treatment+scores+150x150x100+1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="150" data-original-width="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXMu9AMAZklql3jhRdOz_hi6Lr35iL8HcLesn3ZGll1aqZFD2E8w4hk6lLl2Fw3p2w49LsgiNSEUonpx0vT2hlFuWlCglFAuwcDf3ddTcXrRDWtCHW3d3Mawe46PyAzv7t5KAKq2Y9wQw/s1600/treatment+scores+150x150x100+1.png" /></a></div>
<br />
Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM) in order to help patients, doctors, nurses, journalists, writers, bloggers (and everyone else).<br />
<br />
Back in the early days of the computer, you had to know how to use machine language to use a computer. Once a graphical user interface was put over machine language by Windows and Apple everyone could use a computer. With Treatment Scores, we have put a graphical user interface over evidence-based medicine (EBM) so that everyone can do EBM quickly and easily. Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: Evidence-Based Medicine in a format that saves time. All other players in healthcare benefit as well.<br />
<br />
<b>AUDIENCE</b><br />
The essays you write with Treatment Scores will be seen by a wide audience. We have over 100,000 followers on Facebook, over 9,000 followers on Twitter, and we hold all top 10 positions on Google search. As I write this, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency. You can also write for your hometown newspaper and prove to your local community that, with technology, you are the smartest patient advocate in town.<br />
<b><br /></b>
<b>CONTACT</b><br />
If you are interested in Treatment Scores, please email:<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
Feel free to send your LinkedIn profile, CV, or any other information.<br />
<br />
There is a 1 minute explainer video about Treatment Scores on YouTube:<br />
<a href="https://youtu.be/GLIIB3oOVJA">https://youtu.be/GLIIB3oOVJA</a><br />
<br />
There is an explanatory essay about Treatment Scores and Smart Phones here:<br />
<a href="http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html">http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html</a><br />
<br />
Bradley R. Hennenfent, MD<br />
Physician & Economist (Retired)<br />
Florida, USA<br />
<a href="mailto:Dr.Hennenfent@gmail.com">Dr.Hennenfent@gmail.com</a><br />
<br />
<b>ABOUT</b><br />
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.<br />
<br />
To support Treatment Scores and the treatment transparency movement:<br />
<br />
<b>FOLLOW FACEBOOK</b><br />
<a href="https://www.facebook.com/TreatmentScores">https://www.facebook.com/TreatmentScores</a><br />
<br />
<b>FOLLOW TWITTER</b><br />
<a href="https://twitter.com/TreatmentScores">https://twitter.com/TreatmentScores</a><br />
<b><br /></b>
<b>FOLLOW THIS BLOG</b><br />
Follow this blog by submitting your email address into the box near the top right. Then look for a confirmation email!<br />
<br />
<b>DISCLAIMER</b><br />
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues.<br />
<br />
Copyright © 2017 All rights reserved.<br />
<div class="MsoNormal">
<span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">EBM® Treatment Scores<o:p></o:p></span></div>
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BradMDhttp://www.blogger.com/profile/06530664817047555773noreply@blogger.com0tag:blogger.com,1999:blog-3721609999509837563.post-20244175556243167072017-05-30T09:56:00.000-04:002018-02-07T10:10:52.016-05:00Teach the World Evidence-Based Medicine <strong>Teach the world evidence-based medicine, </strong>because<strong> </strong>patients and patient advocates, DESPERATELY want these five horrendous problems solved:<br />
<ol>
<li>There is an 88% health illiteracy rate among patients (Health.gov)</li>
<li>60 to 80% of physicians don't understand treatment effects (CMAJ)</li>
<li>The Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”</li>
<li>PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”</li>
<li>The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).</li>
</ol>
We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to save time for physicians and increase understanding for patients.<br />
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How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our taxes. So, for patients, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."<br />
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Treatment Scores put a graphical user interface (GUI) over evidence-based medicine in order to help the practicing physician.<br />
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Back in the early days of the computer, you had to know how to use machine language to use a computer. Once a graphical user interface was put over machine language by Windows and Apple everyone could use a computer. With Treatment Scores, we have put a graphical user interface over evidence-based medicine so that all physicians can do EBM quickly and easily. Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information; and physicians get what they want: more knowledge, less wasted time, and more money.<br />
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<strong>REVELATIONS</strong><br />
When you do evidence-based medicine with a graphical user interface (GUI), and you quantify the effects of medical treatments, you can make some astonishing discoveries.<br />
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The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.<br />
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Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, with a Treatment Score of 95 (as in 95% cure rate), compared to the old interferon based protocol that has a Treatment Score of 40.<br />
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<strong>A COMPLETE LIST OF TREATMENTS</strong><br />
Patients want a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the subclasses of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here are how the Treatment Scores change depending on your personal preferences.<br />
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Patients want to know about all treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments don’t work. You can even tell patients when the Treatment Score is negative = harmful.<br />
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<strong>AUDIENCE</strong><br />
The essays you write with Treatment Scores will be seen by a wide audience. We have over <b>100,000</b> followers on Facebook, over <b>9,000</b> followers on Twitter, and we hold all top 10 positions on Google search. In combination, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency! You can write for your hometown newspaper and prove to your community that, with technology, you are the smartest doctor in town (if you want to build your practice).<br />
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<strong>CONTACT US</strong><br />
If you are a writer, blogger, reporter, or physician interested in Treatment Scores, please email: <br />
<span style="color: blue;"><a href="mailto:Dr.Hennenfent@gmail.com"><b>Dr.Hennenfent@gmail.com</b></a></span><br />
Feel free to send your LinkedIn profile, CV, or any other information.<br />
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There is a 1 minute explainer video about Treatment Scores on YouTube:<br />
<a href="https://youtu.be/GLIIB3oOVJA">https://youtu.be/GLIIB3oOVJA</a><br />
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There is an explanatory essay about Treatment Scores and Smart Phones here:<br />
<a href="http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html">http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html</a><br />
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Bradley R. Hennenfent, MD<br />
Physician & Economist (Retired)<br />
USA<br />
<span style="color: blue;"><a href="mailto:Dr.Hennenfent@gmail.com"><b>Dr.Hennenfent@gmail.com</b></a></span><br />
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<strong>ABOUT</strong><br />
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.<br />
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<strong>FOLLOW</strong><br />
To support Treatment Scores and the treatment transparency movement:<br />
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<strong>DISCLAIMER</strong> <br />
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational tool. Death or disability can result if you don't see your own medical physician or go to the emergency department for your medical issues.<br />
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Copyright © 2017 All rights reserved.<br />
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